HomeMy WebLinkAbout10-12-2021 Septic Pumping ReportSeptic Tank Pumping / Maintenance
Owner Information
Date:
Owner: ���✓o rte, ��y Phone#:
Property address: Owners address: (if different)
Reason for Pumping:
Method of access:
Condition of tanks:
filter cleaned:
Cc4) No
J n/a
Tank leakage observed:
Gallons removed:
#1 000 #2 /000
Disposal method:
Safety concerns:
Recomme ded repairs-
Tank In
❑ compliance inspection ❑ holding tank Maintenance
manholes ❑ inspection pipe (holding tanks only)
(owner signature req'd if refusing to allow pumping through maintenance hole)
good: � alarm working: �
see -
baffles )
No
n/a
above operating depth: Yes o
below operating depth: Yes
No 01—
n/a
(repairs recommended)
(failing to protect groundwater)
#3 #4 pump tank total 0
municipal [ location:
land apply ❑
ZX I
location:
I hereby certify that I have completed this work in accordance with MN 7083.0770 and any local requirements.
No ation or guarantee of fixture system performance has been nor can be made.
Chip's Septic Service, LLC SSTS License
Maintainer signature 16762 Babcock Avenue #2064
Lester Prairie, MN. 55354
(952)200-3176