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Septic Tank Pumping / Maintenance <br /> www.SepticResource.com (vers 12.4) <br /> Owner Information <br /> Date: � -`���/� <br /> Owner: ���, �'�aw� �l�iG• <br /> Property address: Owners address: (if different) <br /> �a� Q�� �C,�/�� <br /> � /�,,�,�; sS"33j <br /> � <br /> � <br /> � <br /> Tank Information <br /> � <br /> Re�son for Pump�g ❑ compliance inspection ❑ holding tank ❑ maintenance� U�C�� - <br /> Method of access: �manholes ❑ inspection pipe(holding tanks only) <br /> , (owner signature req'd if refusing to allow pumping through maintenance hote) <br /> ' Condition of tanks: <br /> filter cleaned: Y� baf�les good: � alazm working: Yes <br /> No No No <br /> � n/a n/a <br /> Tank leakage observed: above operating depth: Yes o (repairs recommended) <br /> below operating depth: Yes No (failing to protect groundwater) <br /> Gallons removed: <br /> #1 O #2 O #3�#4� pump tank � total Q <br /> Disposal method:N��- municipal ❑ location: <br /> land apply ❑ location: <br /> Safety concerns: M A r� <br /> �ju <br /> Recommended repairs: A ��� <br /> �U U <br /> tS'LuDC�'� �3T �/L� <�/ 3 � �a T'�vl�.x;. �m�.v�� Cr�iJ <br /> Comments: �6�...n..,� Q�,/,,,f.�n <br /> l� � � �:S ,�.. t ��a�S1�! 3s° � �( <br /> n .�� r r .ts �.�c <br /> o��'TR+t�i- �/�.SGUI"� ��d'�:S�c t 3J d� -�- O <br /> c�Gw/ Qi <br /> � rr� Si,vo��7�,A- �}I•+� 1N N�. �l .�v �wy.�r-..�r' �r-�n..cr <br /> 1 hereby cert;�y that 1 ave completed this work in accordance with MN 7083.0770 and arry local reguirements. <br /> No dete 'n on or antee offuture system performance has been nor can be made. <br /> �-�� �s�- R�� ��� ��Z-s�3y� <br /> Ma' iner si ture Company � Phone number <br /> _ .._.� <br /> _ __ -- - ._ __ _ _ _ � <br /> , <br />