|
_r,,,-_,,--,:,. ...,_:__,,,_,_,---:„---_---, -...„-_,:,.„:77.TH:=.7:71:':;;--'-:::'.,7,17-.. ,:.,-...; . ,.:-.- -, . .,; . ,, .,....,. , ,,, ., . ,‘ ..,
<br /> ri . _ : . . ,, - . ..:: : , , . . .. _.
<br /> SEPTIC SERVICES
<br /> r
<br /> SQL-949-277 IiMr, �- ..,. ' . : '58°'4°/2 : ', . :.
<br /> Y -Septic Tank ins:# ect Of/P:ump rig Report
<br /> , • , ': ,This.form:is to•be used by:Licensed Sepfage Haulers who.are In pecting ai>d pumpingfetedo tanks as part of at nk l ds.
<br /> ex sf se tra a
<br /> Sale Ins action or an Operation and drtaintenance Permit. This inspection is"ta be completed by l r, P
<br /> artcl,inspacting the'interior of the':septic tank The inspection scope:�s limited to those details prat can be ocserusd by.
<br /> opening an,access to the septic tank. Specilically,completingthCtorsis
<br /> faro a to u sT requautio r exposing the entire fap:of a
<br /> r r .sepptic tenk�;When i tspecting buried"masonry products.con _
<br /> tyrrownshi.l liage
<br /> Address.. �2 r
<br /> Date Tanks)Inspected/Pumped
<br /> Total.Number of Septic Tanks: rt a
<br /> ".— Tank;#2
<br /> $ Septic•r k Sizes(in gallons:Tank#1 ,,.:
<br /> Tank#9 T nk tl4
<br /> • .Tank Lid•Types OPrecast concrete•6d;• = teal plate..:
<br /> . ORiseriwith secure lid at grade
<br /> Q the
<br /> -:'Lid Condition ..Lids•mnt t ainnd one piece? [ Yes ONa ;
<br /> if No spe ► which,'tank(s}and describe hide
<br /> ecra s fttk ? Yes e
<br /> fl• Tondtion Ae threcks wi isibie gapon the tenor oheans Q ON
<br /> Ci r
<br /> r, If:Yes spec>fy which to wand desc se in detail.
<br /> : r
<br /> calf n
<br /> r Outlet Device Type of outlet devices 0• "T' OPre baffle .,-UVe led elbow .
<br /> 7 e t.. .c... .
<br /> Are the.'outlet devices inw 7cUor?, 2 OYes No
<br /> If No,specify which tank ar�d descnb n detail
<br /> Cheek All That Apply QLiquid level at,:below‘1he outlet:Tank#
<br /> QTank had back from final disposal area—Tank
<br /> . QTank stalled;with an effluentflter-:Tank U.
<br /> �g
<br /> QTank used as pump chamber.—Tank
<br /> 1 Notes orRec .,
<br /> r, .
<br /> coratnendations; - � =.
<br /> r, - r4-
<br /> v
<br /> .. C MVO i
<br /> 1 inspected and pumped the tanks'at the above address and hereby attest-that:the.conditions ad ascribed in this report
<br /> reflect actuai site observations.f undersland'that the County.may require corraCtiva-actiOrt.as the result of this report,and
<br /> that:'any eorreenve action.must be approved by Washtenava County.',:-
<br /> t
<br /> Company NPMe. ' c•
<br /> L.
<br /> Contractor s Signature: Date: 5 C.d `� Li' •
<br /> g Rev.3.a1'I
<br /> 1.
<br />
|