HomeMy WebLinkAbout730 Old Creamery Rd - 210508303007 - 12-08-15 Pumpers Report�a91 c County Systems Cleaners Reporting Form
(Please Print)
Name of Systems Cleaner (' , L ✓waA.,J U +, r,^ v
Name of Service Person �J�Xox Wt , �►
Date of Service
Date of Installation CA Cl
Property Owner S Akwq RQviActij-
Physical Address 75 o
Pav-ce i #- 2105- -0g3 -03 --00(t;.
# f70-3q6-643/
Q Lot_ 0 Subdivision i C rA, a r7 l 4, f v �?'Wc 6
Estimated Tank Size t ` 00 �,� �l o n S Material of Tank
on
# of Manholes 9Depth to Manhole Covers ,
Estimated Volume Pumped l 6'd 0 &m1lonS # of Compartments
Sludge Thickness 00 inches Scum Thickness(�Qinches
V� U
Baffle or Sanitary Tee in Place? Inlet -{. Outlet LINK
Effluent Filter in Place? Y N
Dosing Mechanism Pump Siphon None
Dosing Mechanism / Alarm Functioning Properly Y N
Previous Pumping Date, if known 1124 01 �
Location of Septage Disposal 4 i n L Goan M• f Co VV% e0 S i-i nq CkF 5UVAM� f- Co •Y
General Comments (include any signs of failure and all work in addition to pumping)
Sketch (Location of Tank)
�I.a re -pa rs ,n P_C= 01 P of 6 u t-
l c e,S Yip
I certify that to the best of my knowledge th�7Tesaformation is true and correct,.
