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Septic rank Pumping/Alaintenance <br />Owner Information 0IzzSlu <br />Date: Phone: <br />Owner: - R� _�j i� -AA:, Sn�fP. Email: <br />Property Address: Owner's Address (if different) <br />(o S4 <br />Reason for Pumping: <br />of Access: <br />Condition of Tanks: <br />Filter Cleaned <br />Tank Information <br />Q Complinace Inspection 0 Holding Tank Maintenance <br />0 Manholes O Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />fya Baffles good: Alarm working: f S <br />No o No <br />N/A N/A N/A <br />Tank Leakage Observed: Above operating depth <br />Below operting depth <br />Gallons Removed: <br /># 1 %#2 0` #3 #4 <br />Disposal Method: Municipal: Q <br />Land Applied: 0 <br />Safety Concerns: <br />Recommended Repairs: <br />Comments: <br />Yes (repairs recommended) <br />Ye o (failing to protect groundwater) <br />tank <br />Total <br />Location: Watertown Wastewater Facili <br />Location: <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 erfomance 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 />chipseptic(cr�,gmail.com <br />revised 312025 <br />