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Septic Tank Pumping; / Maintenance <br />Owner Information <br />Tank Information <br />/ <br />Date: , ��� ZQ�Z Gcw�GS! i <br />Reason for Pumping: <br />Owner: / /.i,�-G / ,�,H �S Phone#: A 3 — zzz — <br />_ <br />Property address: Qwaers address: (ifdifrerit) <br />3--lm--anholes ❑ inspection pipe (holding tanks only) <br />(owner signature re(I'd if refusing to allow pumping through maintei <br />ance hole) <br />1 he y certa ,t I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No eterminatio or gitarantee of fiture system performance has been nor can be made. <br />_ Chip's Septic Service, LLC SSTS Lice <br />Maintainer signature 16762 Babcock Avenue #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />Tank Information <br />Reason for Pumping: <br />❑ compliance inspection ❑ holding tank [LI—iT aintenance <br />Method of access: <br />3--lm--anholes ❑ inspection pipe (holding tanks only) <br />(owner signature re(I'd if refusing to allow pumping through maintei <br />ance hole) <br />Condition of tanks: <br />filter cleaned: Yes <br />baffles good: Ialarm working: <br />No <br />0 0 <br />U <br />n/a n/a <br />Tank leakage observed: <br />above operating depth: _des (repairs recommended) <br />below operating depth: Yes L5--> (failing to protect groun(water) <br />Gallons removed: <br />41 2-C�O o #2 l © 0 d <br />#3 —#4 pump tank tl 0 6,3 total VI <br />tl _ <br />Disposal method: <br />municipal E� location: <br />_ <br />land apply ❑ location: <br />_ <br />Safety concerns: <br />s: <br />'c &Z <br />Comments: p <br />1 he y certa ,t I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No eterminatio or gitarantee of fiture system performance has been nor can be made. <br />_ Chip's Septic Service, LLC SSTS Lice <br />Maintainer signature 16762 Babcock Avenue #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />