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Septic Tank Pumping / Maintenance <br />Owner Information <br />'-)ate: T//�� z -1 DELIVERED APR 1.2 2024 <br />Owner: Phone#: <br />Property address: 32-�t'S �^GOwners address: (if different) <br />Tank Information <br />Reason for Pumping: ❑ compliance inspection ❑ holding tank ❑ maintenance / <br />XE j►« . r- ey"-% e_�e j s� -I j J h ( <br />Method of access: E� 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: eS alarm working: <br />No No No <br />n/a n/a n/a <br />Tank leakage observed: above operating depth: Yes No (repairs recommended) <br />below operating depth: Yes (failing to protect groundwater) <br />Gallons removed: <br />91 .3CC\ 92 /, 0CN #3 #4 pump tank -5L'-' 01 total 3/00 <br />Disposal method: municipal E location: 14-, 4v'V-% <br />land apply ❑ location: <br />Safety concerns: <br />'_C1kf_ t> - Y <br />"aJ J11 1144- (dL.1y19 l�'l+gc <br />Rec—omm�ended repairs: Ca �tr� �'uuC� �t�c t 'L-� Ind /1 0 <br />Comments• <br />/[ '1 F�.J r �lr � L �� �K-r�P-. G �l �C�{ C ` { t. i.✓'� � G �'�Ci1 t Y�i <br />1 hereby certify that 1 have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No =rantee of future 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 />a <br />