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Septic Tank Pumping/Maintenance <br />Owner Information <br />—,te: 3�Z(o Z5 <br />Phone: <br />Owner: Cl/V%e 3- <br />Pe-4ce:w-% <br />Email: <br />4Xf/a Ch4eQ 01;/le,— <br />Property Address: <br />Owner's Address <br />if different) <br />( fferent)CA <br />s�,re,ls <br />r61A <br />.Sha.kC <br />a /s'I.ji <br />Tank Information <br />Reason for Pumping: <br />O Complinace Inspection O Holding Tank <br />[i, .-hfaintenance <br />Method of Access: <br />[Manholes <br />O Inspection Pipe <br />(holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Condition of Tanks: <br />Filter Craned <br />Yes <br />Baffles good: es <br />(;es <br />Alarm working: Y0 <br />o <br />No <br />N/A <br />N/A <br />N/A <br />Tank Leakage Observed: Above operating depth <br />Below operting depth <br />Gallons Removed: <br /># 1 `0,0 () #2 `d Q U #3 #4 <br />Disposal Method: Municipal: 0 <br />Land Applied: 0 <br />Safety Concerns: <br />Recommended Repairs: <br />Comments: <br />Yes/ (repairs recommended) <br />Yes/1o(failing to protect groundwater) <br />Location: <br />Location: <br />/` zX <br />tank <br />Total Z () <br />Watertown Wastewater Faci <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 of fu ante has been nor can be made. <br />Chip's Septic Service, LLC & SSTS <br />c- irtzer's Sewer Services License <br />J. <br />02 Babcock Avenue Maintaner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipsepticL&gmail.com <br />revised 312025 <br />