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<br /> i SEPTIC S RU("CES .., ,,.., , „ ,, ,„,.
<br /> 503-949-2772 5=03 SSO 4012 .
<br /> 1 Septic Tank_Inspection/,Pumpng Report
<br /> • , This fame.is to,be used b Licensed Se to e�Haulers who are inspecting'and�pumpin se tic tanks�as part of a Time of t Y F ,9 „. F ' 9 9 F ,
<br /> Sale Inspection or an-Operation'and Maintenance.Permit This inspection rs to be completed by exposing septic lank lids
<br /> ' and inspecting the interior.of the septic tank: The inspection sdope is limited°`to'those details.flrat can be observed by
<br /> opening an access*the septic tank.Specifically, completing this form dons.NOT'requi4.re expgsinq the.entire Op'of a
<br /> sePdC tank.1Nhen inspecting buriedmasorirj,ti!oducts,•contractors are urged to tise caution.
<br /> Address" � -
<br /> Z-tS C' (vt,,i��, i .. fi CitylTOwnshtpMllage: (cart"°",C {Z `1?32.
<br /> Date Tank(s)InspectedlPumpeds l b/i6''/^� _ ,,- ,
<br /> tt
<br /> Total1Nurriberof septic:Tanks: .
<br /> Septic Tank Sizes„lip, lions Tank#t ►6dhv Tank 2'• Tank Tank#4
<br /> .... g ). � - tl3
<br /> Tank Lid•TYFas „Precast concrete kd
<br /> OSteel plate �' ,,
<br /> Riserlwith secure lid at grade DOther
<br /> Ltd COndrition; Lids intact and n one pieces Yes O No
<br /> if No,specify which tank,(s)and descnhe•in detail.
<br /> I,, ;. 44.:
<br /> Tank Gonditiori Are there cracks with visible gaps oIh the interior of the,tanks? DYe No
<br /> df Yes;specify which tank(s)arid.describe'in detail
<br /> {
<br /> Outlet Device: • "Type•of'outletde'vicesi f3uttef"T 'QPrecast•baffle' OVented elbow
<br /> Are•the outlet devices intactifunctiorial? Dyes bNo
<br /> ,lf•No,s eci wti
<br /> P tYa jOh tatik(s)add describe in detach' -;
<br /> Check';gll ThatA t �' �r
<br /> pA y sW Liquid level at or below the outlet-Tank#
<br /> t
<br /> ®Tank.had runback from final disposal area, Tank#,
<br /> 1 - ❑Tank,is installed with an effluent filter=
<br /> . Tank#
<br /> ❑Tank,used asapump chamber Tank.#
<br /> s,
<br /> Notes or Recommendatlions siH ti
<br /> �}� y ((\\ '.r
<br /> c1 . 0.rLkx. ltcA 6t,A Alt• boe . :n
<br /> I mspeeked nd,pumpe ,440 tanks`at the above address and hereby attest thatlhe condibons as desctitsdd iilItt '!` •
<br /> z reflect actual site observations i understand that the County;ma' require corrective;action as the`result of,this re`"
<br /> that any°corrective actionsinust bea roved b •tF ` y . A�,1 '
<br /> ,•� ` .PP �yiWashtenaw County , �s r 4 a� port and..
<br /> Com any Name '4"
<br /> Contractor's Signature : „ �.%�..L � ^
<br /> Date _LL �`
<br /> d� 42ev38.11 4
<br /> x •
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