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Septic Tank <br />Pumping '': <br />Givner Information <br />Date: -s/l'! f Zp 2-3 <br />Owner: OSS hT 4Zr w v` Phoneu: <br />'' moi` 7 <br />Property address: Owners address: (if different) <br />7-Y00 S -r <br />Tank Information <br />Reason for Pumping: ❑ compliance inspection D holding tank [tmvintenance <br />Method of access: D Manholes D inspection pipe (holding tanks only) <br />(owner signature req'd if refusing to allow pumping through maintenance hole) <br />Condition of tanks: <br />filter cleaned: es baffles good: alarm working: �j <br />OF o NO <br />n/a n/a n/a <br />Tank leakage observed: above operating depth: Yes o (repairs recommended) <br />below operating depth: Yes _ o (failing to protect groundwater) <br />Gallons removed: <br />#irju #2 130 V #3 #4 pump tank '%M total 3 <br />Disposal method: municipal C� location: ,7`�'�-•'1 <br />land apply ❑ location: <br />Safety concerns: // <br />Recommended repairs: <br />Commen : <br />hal'p <br />-7t- 3 -e " cam., '- Do - ' reurt 0(;r4. <br />_1.- Qaa cep a e'—''41'_g✓ /74 -Lt I, q rp��s orb <br />1 hereby certify that I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No or guarantee offitttrre system pe�forntance has been nog- can be made. <br />Chip's Septic Service, LLC SSTS License <br />Maintainer signature 16762 Babcock Avenue #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />