HomeMy WebLinkAbout12-8-23 Septic Pump ReportProperty Owner;- A-- �.�, ; ,�
Street Address: Q C( t`� -V;jrc, 5
City / Zip Coder ti . ,,,A y-,,�J (
Septic Site Address if Different from Homeowner's Address:
Street Address:
City / Zip Code:
Number of Tanks Pumped: Type of Tanks: Tanks Pumped via: Total Volume Pumped: GALLONS
91 CaPrecast / Concrete E -Manhole / Riser Manhole(s) to Grade? Yes No
❑ 2 O Combo ❑ Inspection Pipe Manhole Covers Secure? / No
❑ 3 ❑ Plastic Baffles: / No
Other: ❑ Cesspool
Pumping Date: A< MPCA License #: Maintenance Provider Name -)w'
Septic stem comments: C2(5
p Y _ -
*Minnesota state taw requires septic tanks to be evaluated every 3 years.
**This postcard does not require postage and our address is pre -addressed. Please call (612) 543-5200 with any questions. Thank you.