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Septic Tank Pumping / Maintenance <br />Owner Information <br />Date: /_ b�l 71 DELIVERED NOV 2 2 2024 <br />Owner: A-7, ,S Phone#:- �'/ Z - $ `/Z7 •- 6y?z <br />Property address: Owners address: (if different) <br />Ci�Ja zcz 4r- <br />( Tank Information <br />n for Pumping: <br />Method of access: <br />Condition of tanks: <br />filter cleaned: Yes <br />No <br />Tank leakage observed: <br />Gallons removed: <br />41 )0 42 l o u <br />Disposal method: <br />❑ compliance inspection ❑ holding tank �aintenance <br />C—Iii-anholes ❑ inspection pipe (holding tanks only) <br />(owner signature req'd if refusing to allow pumping through maintenance hole) <br />baffles good: es alarm working: es <br />No 0 <br />n/a n/a <br />above operating depth: Yes o (repairs recommended) <br />below operating depth: Yes (failing to protect groundwater) <br />#3 #4 pump tank 160 U total <br />municipal L location:_ /, lc —k <br />land apply ❑ location: <br />Safety concerns: / Zoo <br />/ / �"% <br />Zoo r I6 eG^)' — .C� e- k— j 1 <br />,commended repairs: <br />novi <br />3 y e <br />I hereby certify that I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No determination or guarantee offuture system performance has been nor can be made. <br />Chip's Septic Service, LLC <br />Maintainer signature 16762 Babcock Avenue <br />Lester Prairie, MN. 55354 <br />(952) 200 3176 <br />SSTS License <br />#2064 <br />