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Septic Tank Pumping/Maintenance <br />Owner Information <br />Date: <br />�'� Phone: <br />Owner:t 1 c' . , j-r Email: <br />Property Address: Owner's Address <br />(Reason for Pumping: <br />Method of Access: <br />(Condition of Tanks: <br />Filter Cleaned <br />(Tank Leakage Observed: <br />Gallons Removed: <br />#1 //vv1 #2 <br />(Disposal Method: <br />(Safety Concerns: <br />(Recommended Repairs: <br />Comments: <br />Tank Information <br />(if different) <br />❑ Complinace Inspection ❑ Holding Tank (Maintenance <br />to Manholes 0 Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Yes Baffles good: Y,t�s Alarm working: Vs <br />No No No <br />/ A N/A N/A <br />Above operating depth Yes/o (repairs recommended) <br />Below operting depth Yesyo (failing to protect groundwater) <br />#3 <br />Municipal: <br />Land Applied: <br />#4 <br />tank <br />Total <br />0 Location: Watertown Wastewater F <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 of future 7er ce 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@gmail.com <br />revised 312025 <br />