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Report Pi'tc'5- 503.663.2807 SPEEDY SEPTIC /o�7) �a) &4LtLc Servjc SpeedySepticService.com setting a higher standard SEPTIC SYSTEM STRESS TEST #of rooms 1 #of residents / Date TECHNICIAN �'e last pumped History of backing up Yes &b7 �'G 1/7 / Tank uncovered 0 No f SALES ORDER# 11/ /G/ If No,informed of charge to uncover? // Tank has pump and screens? Yes DATE 7-1r - l 5 PROPERTY INFORMATION Type of tank: N H,,,„,. ,. c NAME J r,G e ..,r 11111 In ADDRESS 1F 5 G./ Lit li If- S Inlet line material Plastic Cast iron t CITY 10,q rqf ©I\ Material of tank Concrete Plastic _Steel Fiberglass EMAIL G Distribution box uncover Yes No* PHONE , '� 9?/'� 111:79 -91d?, deemed How did you hear about us? *Homeowner ari P S FAIL Q Liquid level at time of arrival SYSTEM FAILURES N )0 0 Level of solids at time of arrival �", p rn Q Condition of cleanout c lz) Q Tank access meets DEQ code aZl = p Q Tank lid properly sealed a p Q Proper slope of inlet line from house to tank Q Signs of sewage above normal level pQ Signs of root infiltration PASS FAIL a © Q Tank size appropriate for residence 1- .0 Q Condition of tank aCS Q Internal tank plumbing adequate I.+ 0 Q Tank draining properly PASS FAIL SYSTEM LAYOUT Q Q Condition of distribution box ih as acc Q Q Outlet line has proper slope — .t JW m Q Q Pipes free of buildup rr �� z Q Q Proper flow of sewage t ic 1" K g m Q Q Distribution box draining properly tl c — 0 Q Solids present in distribution box x,. Q Q Condition of drain field 0 Q Drain field appears free of excess moisture, sewage or odor Approximate distance between well and drain field** "This portion of the stress test includes 30 minutes to locate and excavate the distribution box and assumes that accurate asbuilts are "Possible contamination to drinking water may occur.Code requires 100 feet from drain provided,depth to box is less than 24"and there are no complicating features obstructing the location and excavation process.If the field to well. process exceeds the 30 minute allotment,additional charges may apply. y JOB COMPLETION WORE ' �� C. AMOUNT ,7/6°1 3-- Q Properly closed tank cover t't'F4 SVO a 1/<6/sS Y Z �� Q Returned sod and backfilled tank // .9 ,�2� Q Checked flow from house to tank 2- _ lE f '7.�_ V G r 9 z8,'(4' PAYMENT SIGNATURE _ DATE TOTAL 3 VISA/MC# Next pumping do be done in 1 2 3 4 5 6+ YEARS EXP. DATE CHECK# TELL US HOW WE DID How likely are you to refer us to a friend or neighbor? NOT likely 1 2 3 4 5 6 7 8 9 10 VERY likely Based on what we were able to observe and our experience with on-site wastewater technology,we submit the Sewage Treatment System Evaluation Report based on the present condition of the on-site sewage treatment system.Speedy Septic has not been retained to warranty,guarantee,or certify the proper functioning of the system for any period of time in the future .Because of numerous factors(usage,soil characteristics,previous failures,etc.)which may aff ect the proper operation of the septic system,as well as the inability of our company to supervise or monitor the usage or the maintenance of the system,this report shall not be construed as a warranty by our company that the system will function properly for any particular buyer.Speedy Septic DISCLAIMS ANY WARRANTY,either expressed or implied,arising from the inspection of the septic system or this report.We are also not ascertaining the impact the system is having on the ground water.Furthermore,this report will be considered invalid if any information provided by the applicant is determined to be inaccurate. k