Report X1,1- ao2_3
SEPTIC SYSTEM STRESS TESTS Office Phone
� -
503.663.2807
www.speedysepticsystem.com
I ' 1 L '- ,'/
Technician: h i Date: / / ' °
Client Name: _ n'Y1-,,' -i, - i ts \ Property Information
Property Address: , a r , ' . -.1,._ ‘ .(L ,', --, # of Rooms: 6,
# of Residents:
City: - I t C(_ St. - ".:), Date Last Pumped:
v
Email: History of Backing Up: Yes (
Phone: 5.',.. (.'" _-2 a ;3
r)_, , Tank Uncovered? ' No
How did you hear about us? If No, Informed of Charge to Uncover
Tank have Pump & Screens Yes <No
Inlet and Access Notes
Condition of Cleanout Functional Damaged No Cleanout,
Tank Has Riser To Grade ( meet code) Yes ; No - ' - a
Is the Odor Seal in Good Condition Yes ' No Not Present-
Proper Grade of "Inlet Line" from House to the Tank Yes ' No
"Inlet Line" Material Plastic Cast-iron-' Other
Signs of"Effluent" Ponding above Normal Level , Yes e No
Signs of Root Infiltration Yes C No 1
Tank Notes
Liquid Level at Time of Technician's Arrival Normal Low ` High . a ,
Level of Solids at Time of Arrival - Normal r Bad - ".•' Excessive -
Type of Tank . Concrete Steel Plastic Fiberglass
Condition of Tank Good Fair. , Poor ") Hazardous -
Condition of "Baffles" in Tank "Inlet" Good Bad *See Notes
"Outlet" Good Bad *See Notes
Approx. Size of Tank
Exit / Drain Field / Distribution Box - Notes
"D -Box" Uncovered Yes Not Exposed*
Does "Outlet Line" Have Proper Grade Yes No
- - Are the "Pipes" Free of Build -Up Yes No . . __ , _ ___ A -- _
Condition of "D -Box" Good Fair Poor
"Effluent" distributing properly Yes No
Does Ponding Exist in "D -Box" Yes No !i
Solids Present in "D -Box" Yes No .
Drain Field Compromised Yes No *See Notes '''" t ',
Di am Field Appears Free Of excessive moisture, Yes No t - , C, � "—
sewage, or odor
This' portion of the stress test includes 30 min. to locate and excavate the Distribution box and assumes that
accurate asbuila are provided, depth to box is less than 24" and there are no complicating features obstructing the location
and excavation process If the process exceeds the 30 rain allotment, additional charges may apply.
Job Completion Description Work , Amount
t
Properly Closed "Tank Cover" ® `i''? r ' `) , r ' t
Returned Sod and Backfilled Tank U - -
Checked Flow From House to Tank L -
Does the Separation Between Well &
Septic System Meet Local Requirements
Yes No NA
If -'1 nswer is "NO" Possible Contamination to _
' Drinking Water May Occur! Code Requires 100
feel from Drain Field to Well r
Technician Signature:,: , .�= t - t
.r^ .. f„,....! + ,
Date: ,.✓ _ k` _ p
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Next Pumping To Be Done in 1 2 3 4 5 6 +-- YEARS , 1 I TOTAL 11 /., - c ,, ,
_ 1
Payment: Check# - /D Cu stomer Signature: , .. ►' ` i l t't / /
Visa /MC# Date: -7 ,/ 11- / L- =✓ el
Exp Date: r
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 warrant, guarantee, or certify the proper functioning of the
system for any period of time in the future Because of the numerous factors (usage, soil characteristics, previous failures, etc.) which may affect the proper operation of
a septic system, as well as the inability of our company to supervise or monitor the use 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