Laserfiche WebLink
, Septic Tank Pumping / Maintenance R����v�� <br /> , <br /> JUL 0 6 Z011 <br /> Owner Information <br /> Date: �n �.�d . ) '7 C1TY OF O ONO <br /> Owner: Doboszenski&Sons <br /> Property address: Owners address: (if different) <br /> 1700 Shoreline Dr <br /> Orono,MN 55391 <br /> Reason for Pumping: ❑ compliance inspection ❑ hold.ing tank ❑ maintenance <br /> Method of access: � manholes ❑ inspection pipe(holding tanlcs only) <br /> (owner signature req'd if refusing to allow pumping through maintenancc hole) <br /> Condition of tanks: <br /> filter cleaned: Yes baffles good: Ves alarm working: Yes <br /> No No No <br /> n/a n/a n/a <br /> Tank leakage observed: above operating depth: Yes tvo (repairs recommended) <br /> below operating depth: ves No (failing to protect groundwater) <br /> Gallons removed: <br /> #1 U� #2 /$l�J #3 #4 ptunptank_� total��'� <br /> Disposal method: municipal � location: [,�f���,. -�-�w� <br /> land apply ❑ location: <br /> Safety concerns: <br /> Recommended repairs: <br /> Comments: _�' <br /> - 1 BiN� Gt�n��o,dm�.�'i' <br /> !hereby cer1�tha11 have completed this work in accordance with MN 7083.0770 and any loca!requirements. <br /> No delermin ' or guarantee ojfuture sys�em performance has been nor can be made. <br /> Kothrade SWE, MPCA#0192 763.498.8702 <br /> Maintainer s' ature Company Phone number <br />