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Septic Tank Pumping/Maintenance <br />LAIQ <br />Owner Information <br />Date: Phone: /02 - 7 -3,2 yY <br />Owner: 4,,,k�n ��j� Email: <br />Property Address: Owner's Address (if different) <br />/glib Fx S4 <br />�Way Zk4zx /YIN <br />Tank Information <br />Reason for Pumping: ❑ ComplinaceInspection ❑ Holding Tank (Maintenance <br />Method of Access: Manholes ❑ Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Condition of Tanks: <br />Filter Cleaned Yes Baffles good: Ys Alarm working: As <br />No No No <br />I/A N/A N/A <br />Tank Leakage Observed: Above operating depth Yes/yo (repairs recommended) <br />Below operting depth Yes9eo (failing to protect groundwater) <br />Gallons Removed: <br />#1 p #2 #3 #4 Pump tank c:r"Ov Total 07 <br />Disposal Method: Municipal: Location: Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />I Safety Concerns: <br />lRecommended Repairs: <br />(Comments: <br />1 hereby certify that 1 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 Maintaner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipsepticna. nail.com <br />revised 312025 <br />