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Map <br />Include location of building sewer, septic tank(s), soil dispersal system, cesspools, seepage pits, and other pits. Also <br />include a permanent reference point(s) and dimensions. <br />T North <br />�o <br />Tomb <br />o � <br />0 <br />Certification <br />I hereby certify the system was abandoned in accordance with Minn. R. 7080.2500 and any local requirements. <br />Name (please print): Corey Scherber Title: Owner Scherber Companies LLC <br />Address: 20160 75th Ave N <br />City: Corcoran State: MN ZIP: 55340 <br />Phone: 612-282-7403 License # if applicable): PB644183 <br />Date: 9/9/2021 Signature: 41911a.--- <br />www.pca.state.mn.us - 651-296.6300 - 800.657-3864 - TTY 651-282-5332 or 800-657-3864 - Available in alternative formats <br />wq-wwests4-03 - 11121108 Page 2 of 2 <br />