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Septic Tank Pumping/Maintenance <br />Owner Information D 9 <br />Phone: .��_ 7 _ L;- <br />Owner: Email: <br />Property Address: ULiC N Owner's Address (if different) <br />�s3s� <br />Tank Information <br />Reason for Pumping: ❑ Complinace Inspection O Holding Tank Q�Maintenance <br />Method of Access: Q-K' nholes ❑ 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: 0 es Alarm working: Xss <br />No No No <br />N/A N/A <br />Tank Leakage Observed: Above operating depth Yesh�(repairs recommended) <br />Below operting depth Yes/ <br />1(�o�(failing to protect groundwater) <br />Gallons Removed: <br /># 1 / Z52 #2 2 5-u #3 #4 Pump tank '7-<7-) Total � Z-,>b <br />Disposal Method: Municipal: Q Location: Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />Safety Concerns: <br />Recommended Repairs: lv?,P"-j -/-) -,t;jex — <br />Comments: r� 1J Jf-L. , -I / -L I. - <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 offuture75tan:nature <br />hasor can be made. <br />Chip's Septic Service, LLC & SSTS <br />Sf--�rtzer's Sewer Services License <br />i .,2 Babcock Avenue anerSig#2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipsepticgmail.com <br />revised 312025 <br />