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Septic crank Pumping/Maintenance <br />Owner Information <br />Date: 5 - ` Phone: =V ` 601k <br />Owner: Email: <br />Property Address: Owner's Address (if different) <br />-10 <br />Tank Information <br />Reason for Pumping: ❑ Complinace Inspection ❑ Holding Tank '0 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 goodies Alarm working: <br />es <br />No �'0 No <br />,/ A N/A N/A <br />Tank Leakage Observed: Above operating depth Yesyl o (repairs recommended) <br />Below operting depth Yesyo (failing to protect groundwater) <br />Gallons Removed: <br /># 1 /dU[> #2 &0 #3 #4 Auj 7-v,4, r P&-ef� 0- <br />4- <br />Disposal Method: Municipal: <br />Land Applied: <br />Safety Concerns: <br />lRecommended Repairs: <br />(Comments: <br />Pump tank Total jloo <br />Q Location: Watertown Wastewater Facility <br />O Location: <br />I 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 />chipsepticQgmail.com <br />revised 312025 <br />