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Septic Tank Pumping / Maintenance <br />Owner Information <br />Hate: _ <br />DELIVERED AUG 16 2024 <br />wner: �<% Sn ci,-7 -- Phone#:�-�`,i <br />Property address: Owners address: (if different) <br />Tank Information <br />Reason for Pumping: ❑ compliance inspection ❑ holding tank LC{ aintenance <br />Method of access: manholes ❑ 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: Yes baffles good: j alarm working: <br />No �`� No <br />n/a n/a n/a <br />Tank leakage observed: above operating depth: Yes i'o (repairs recommended) <br />below operating depth: Yes ' _ (failing to protect groundwater) <br />iallons removed: <br />#1 `D6y #2 /00 v #3 _ _#4 pump tank _�ZU total y to <br />Disposal method: municipal Nl-� location: % L <br />land apply ❑ location: <br />Safety concerns: <br />tlrn t _ <br />Recommended repairs: <br />i'lQ�n t <br />Comments: <br />Anne& s a o o d - Gi l/ G2�-� , � l.Jr- ,L'� 5 p✓G�.�! <br />I hereby certify that I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No dil inatt 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 />