Courtesy Sewer Plunge Form

Was the problem remedied?

Yes

(if no explain below)

Date Completed

Performed by:

Today's Date

What color is your house?

Address

Your printed name below will be used as your signature*

Name:*

Email:*

Phone*

Agree to terms by checking box below:*

I give permission for The Pitman Public Works Water and Sewer Division to perform a courtesy plunge at my sewer vent. I understand that this may not remedy the problem and I may need to contact a plumber for repair. In addition, by signing below, I Hold Harmless the Borough of Pitman and its employees for any damages as a result. Damages could include but are not limited to sewage leakage into basement and or broken sewer vent and piping. Please place your signature and date in the box below. This will represent your signature.

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Courtesy Sewer Plunge Form

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Borough of Pitman, NJ

Courtesy Sewer Plunge Form

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