Laserfiche WebLink
Septic Tank Pumping / Maintenance <br />Owner Information <br />Date: <br />Owner: f p D C S /' _ <br />Property address: // Q <br />7- x �� 3 <br />Reason for Pumping: <br />Method of access: <br />Condition of tanks: <br />filter cleaned: Yes <br />No <br />t <br />Tank leakage observed: <br />DELIVERED AUG 16 2024 <br />Phone#: 9S, _ 3SZ — 3 y b r_ <br />Owners address: (if different) <br />Tank Information <br />❑ compliance inspection ❑ holding tank [—maintenance <br />L�tnholes ❑ inspection pipe (holding tanks only) <br />(owner signature req'd if refusing to allow pumping through maintenance hole) <br />baffles good: alarm working: es <br />No No <br />n/a n/a <br />above operating depth: Yes No (repairs recommended) <br />below operating depth: Yes No (failing to protect groundwater) <br />gallons removed: <br />* 1 S—b #2 _ ( ) b U #3 #4 pump tank total 27_1Z.3 <br />Disposal method: municipal 19� location: <br />land apply Ellocation: <br />Safety concerns: <br />Recommended repairs: r `/ <br />IQLY►�it n%� Rea <br />CA /ytE :mod �P ^e v cLW / c <br />�- -e <br />7- <br />t � • �� G lL �( 1 <br />I hereby certify that I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />etermzrzu or guarantee offuture system performance has been nor 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 />