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1 <br /> 1 <br /> 1 <br /> v <br /> i C�t,,k l --2 <br /> i <br /> , ECO <br /> SEPTIC SERVICES <br /> 1 503-949-2772 (���.r �. <br /> 503-580-4012 <br /> Septic Tank inspection/Pumping Report <br /> This form is to be used by Licensed Septage Haulers who are Inspecting and pumping septic tanks as part of a Time of <br /> Selo inspection or an Operation and Maintenance Permit.This inspection is to be completed by exposing septic tams lids <br /> and inspecting the interior of the septic tank. The inspection scope is limited to those details that can be observed by <br /> opening an access to the septic tank.Specifically,completing this form does NOT require exposing(he entire top of a <br /> septic lank When inspecting buried masonry products,contractors are urged to use caution. <br /> Address: 4.i3 9.o View Cush' A CityfTownshiplvillage: cal Q cj 0 - <br /> Oats Tank(s)Inspected/Pumped: / 1. ?,Ct <br /> i <br /> TohlNirmberofSepticTanks: 4. <br /> Septic Tank Sizes(in gallons):Tank#1 WOO Tank#2 Tank#3 Tank n4 <br /> Tank Lid Types: QPre . t concrete lid USteel plate <br /> QRiserlt'th secure lid at grade QOther, <br /> j • Lid Condition: Lids intacta i''in one piece? °Yes °No <br /> 1 If No,specify ti ,ich tank(s):and:describe ind- .ii: <br /> Tank Condition: Are there cracks with vi `.le gaps the interior of the.tanks? DYes QNo <br /> If Yes,specify which tank( an• .escribe in detail: <br /> Outlet Device: Type of outlet devices: QOutiet'T" El Precast baffle QVented elbow <br /> Are the outlet device intactifunctiona QYes DNo <br /> If No,specify whic tank(s)and itescrib-in detail: • <br /> I Check All That Apply: CI Liquid l-yet at or below the outlet-Tank# <br /> , ' QTank,.d.runback from final disposal.area-Tank# <br /> A ❑Tank is installed with an effluent filter-Tank# <br /> 1 ❑Tank used as pump chamber-Tank# <br /> t <br /> i Notes or Recommendations: <br /> t <br /> 3 <br /> a I inspected and pumped the tanks at the above address and hereby attest that the conditions as described in this report <br /> reflect actual site.observations.I understand that the County may require corrective action as the result of this report,and <br /> that any corrective action must be approved by Washtenaw County. <br /> Company Name:. PC© _ Lrn.r <br /> q Contractor's Signature: Date:4 'l2-( <br /> I <br /> - is, . f' k.... ' . . 4 . ? i 3 ! i. 2 I l 1. 1 i i E I } 1 7 1 , d1 n ., 1 3 ' <br /> i <br /> i <br /> i <br /> I <br /> a <br />