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Septic Tank Pump ing/Maintenance <br />Owner Information <br />Date: �5/ z a z 5- <br />Owner: /4?055 oetwn <br />Property Address: <br />140,, d /YI� 'SSU y <br />(Reason for Pumping: <br />Method of Access: <br />Condition of Tanks: <br />Filter Cleaned <br />Tank Leakage Observed: <br />Gallons Removed: <br />41 ZZS7� #2 <br />Disposal Method: <br />Safety Concerns: <br />Recommended Repairs: <br />Comments: <br />Tank Information <br />Phone: 6 /Z — ZZ7 - % 3 6l <br />Email: <br />Owner's Address (if different) <br />❑ Complinace Inspection ❑ Holding Tank (Maintenance <br />'Manholes ❑ Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Yes Baffles good: Y-09- Alarm working: Yes - <br />No No <br />N/A <br />Above operating depth <br />Below operting depth <br />#3 #4 <br />Municipal: <br />Land Applied: <br />&ja4,- le,c <br />-Ad lc i/'i-d • a <br />tank 75� Total 3000 <br />Q Location: Watertown Wastewater Facili <br />❑ Location: <br />tr, <br />i' oa -),-r <br />4-, <br />pi <br />6.4 <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 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 />chipsepticQjzmail .com <br />b <br />No <br />N/A <br />Yes/No (repairs recommended) <br />Yes/No (failing to protect groundwater) <br />revised 312025 <br />