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Septic Tank Pumping/Maintenance <br />Owner Information <br />Date: f 2Z Z Z Z ZS Phone: �l Z- 7 V7 <br />Owner: �l A. a q, Email: <br />Property Address: Owner's Address (if different) <br />Dren o , MIU 1S7S3Q1 <br />Tank Information <br />Reason for Pumping: ❑ Compi i nace I nspection ❑ Holding Tank L iaintcnance <br />Method of Access: (3-0aanholes ❑ 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: Fo <br />Alarm working: <br />No No <br />N/ N/A N/A <br />Tank Leakage Observed: Above operating depth s(N (repairs recommended) <br />Below operting depth 16s (failing to protect groundwater) <br />Gallons Removed: <br />#! 1,300 #2 1,560 #3 #4 Pump tank -ISO Total <br />Disposal Method: Municipal: Q Location: Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />I Safety Concerns: <br />lRecommended Repairs: <br />(Comments: <br />ee.-k 74A.-i IL Z.x <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 of filtu mance 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 />chipsseptic(a7,gmail.com <br />revived 312015 <br />