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TOWNSHIP ENVIRONMI ‘AL SERVICES Septic Tank Pumping Certificate ‘Owner Name. Date of pumping , Transfer of Proper Project Address Routine Pumping Existing tank-new system Septic Tank Size:__ Inlet Baffle: 1D Holding tank Material 0 Alarm present Intact? Yes LJ No IF SYSTEM INCLUDES. O Yes 1] No MORE THAN ONE TANK, COMPLETE THIS SECTION FOR EACH ADDITIONAL ‘TANK ON A SEPARATE CO other No PUMPING CERTIFICATE FORM AND ATTACH. Additional tank(s) au pera peibsecaae eaaa Rules, apt 70600175 Sp... he ona ov ore’ get refi a all the remove ccess | trough a matntononce Hyitzhtemance cress | Serica *Reason for pumping through inspection pipe: ‘pumped through inspection pipe: “Homeowner signature-it| Maintenance Access Present? ["] No O yes Diameter of maintenance access: ___ inches at least dimension (must be 20” to be part of new system) Access within 12” of ground surface? Risers (ClewstngLladded): Inspection pipes present? (Yes — Inlet / Outlet / Center Oi concrete {J Yes — on Inlet / Outlet / Center No 21 Plastic LI No Added to: Inlet / Outlet / Center C)None OAddea in./ft. to Inlet / Outlet / Center The septic tank [] Does / (] DOES NOT appear watertight as of today’s date. Tank leakage observed below operating depth? Yes [JNo ‘Tank leakage observed above operating depth? Yes EJNo Any drainback from soil treatment area noticed? [] Yes [] No Disposal method: [1] Municipal treatment. Land application O other Comments/observation of any non-compilance/repairs: ‘Thereby certy with iy signature 3s @ MPC lcensed Porper thet my observations recarded on ls form are accurate (o the Best of my professionel ‘nvontedge 28.0 the dete signed for the property stated above, No determination of ture performance can be made due to unknown conditions such 25 abuse ofthe system, and/or hadequate maintenance, of which wil adversely affect the Ue ofthe system. Bumper name (Pease print)