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Septic Tank Pumping/Alaintenance <br />DELIVERED NOV .0 3 2025 <br />Owner Information <br />Date: /D -al - Ss <br />Owner: IRS# <br />Property Address: <br />O Mly 6S3s-ra <br />(Reason for Pumping: <br />I Method of Access: <br />Condition of Tanks: <br />Filter Cleaned <br />Tank Information <br />Phone: <br />Email: <br />Owner's Address (if different) <br />❑ Complinace Inspection ❑ Holding Tank 9 Maintenance <br />Pr Manholes ❑ Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />VS Baffles good: Yle Alarm working: Xs <br />o No No <br />N/A N/A N/A <br />Tank Leakage Observed: Above operating depth <br />Below operting depth <br />Gallons Removed: <br />#1 /UOU #2 &juy #3 /Oov #4 <br />Disposal Method: Municipal: 0 <br />Land Applied: ❑ <br />Safety Concerns: <br />Recommended Repairs: <br />Comments: <br />Yell' (repairs recommended) <br />Yes/o (failing to protect groundwater) <br />tank <br />Total <br />Location: Watertown Wastewater Faci <br />Location: <br />I hereby certify that I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No determination or guarantee offuture system perfomance has been nor can be made. <br />Chip's Septic Service, LLC & SSTS <br />Swartzer's Sewer Services <�\—�License <br />16762 Babcock Avenue Main aner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipseptic(cr�,gmail.com <br />revised 312025 <br />