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Septic Tank Pumping / Maintenance <br /> www.SepticResource.com (vers 12.4) <br /> JOwner Information <br /> Date: — / /s- <br /> 1 <br /> Owner: , -s �..,�k C <br /> Property address: Owners address: (if different) <br /> C Q;J ,�sl an.o(l P c , ge.K I Yb' <br /> (Jrvalat /1A/ ce..IA.;`o� ; A1, _53-33 / <br /> Tank Information <br /> Reason for(Pumping) ❑ compliance inspection 0 holding tank ❑ maintenance )Q s[,ubC( 1*sr <br /> Method of access: manholes CI inspection pipe(holding tanks only)\ <br /> (owner signature req'd if refusing m allow pumping through maintenance hole) <br /> Condition of tanks: <br /> filter cleaned: Yes baffles good: Yes alarm working: Yes \ <br /> No No No <br /> n/a n/a n/a <br /> Tank leakage observed: above operating depth: Yes 10 (repairs recommended) <br /> below operating depth: Yes to I (failing to protect groundwater) <br /> Gallons removed: <br /> #1 U #2 0 #3 #4 pump tank U total 0 <br /> i <br /> Disposal method:A✓/4 municipal ❑ location: <br /> land apply ❑ location: <br /> Safety concerns: <br /> Recommended repairs: <br /> /3Nc <br /> LLIDC(r TeS rel a TS wu 114.- r=t h kf . <br /> Comments: <br /> /s i TA .x N'S(-t.; 10"o g 4 cog z(-.2qd/ 4 c`.c.,+y /�c,,>v`'' A-6 P� ,i�T <br /> v2►.d irLt,k /t)St.-ueh /vi��,� SIu�L z �`(°l� �e`'ti.2 <br /> �, , �µk= N� si_,�fy.0:6 Si. �'04E- dirket 7—/-�;,r�{ <br /> Pe•R CA"C . c Ls-/b it . /�6A ffV' r tl ,Tv At& •-c'1(p r e4- tvv°rNA601,-601,44-m- pc,4n, 4 .I cz.-il,cti <br /> I hereby certify t r•I have completed this work in accordance with MN 7083.0770 and any local requirements. <br /> No d nati•j7,r guarantee offuture system performance has been nor can be made <br /> /9/6;is S Pwop; )S1 i_.c..c- 6/.2 —337-35 <br /> intainer ignature Company . 334' J Phone number <br />