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Septic .Tank Pumping/Alaintenance <br />Owner Information <br />Phone: <br />Owner: i_�k! <br />Email: <br />Address: <br />��... Owner's Address <br />Reason for Pumping: <br />of Access: <br />of Tanks: <br />Filter Cleaned <br />Tank Information <br />❑ Complinace Inspection ❑ Holding Tank <br />V.-dw � W � <br />(if different) <br />Maintenance <br />Manholes ❑ Inspection Pipe p (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Yes Baffles good: >/es Alarm working: e0s <br />No NoY"'N/A <br />N/A <br />Tank Leakage Observed: Above operating depth <br />Gallons Removed; Below opening depth <br /># 1 -> #2 #3 #4 <br />Disposal Method: Municipal: <br />Land Applied: ❑ <br />Safety Concerns: <br />mended Repairs: <br />ents: <br />Ye (repairs recommended) <br />Y o(failing to protect groundwater) <br />Pump tank 7 Q Total 0`�',7n—c) <br />Location: Watertown Wastewater <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 syste a omance has been nor can be made. <br />Chip's Septic Service, LLC & <br />S—rtzer's Sewer Services SSTS <br />I - ..,2 Babcock Avenue License <br />M <br />Lester Prairie, MN. 55354 aintaner Signature #2064 <br />(952) 200-3176 <br />chi se �ticicinaii.com <br />revised 312025 <br />