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Septic Tank Pumping/Maintenance 624166 <br />Owner Information <br />Date: _ Phone: �%Z "'=��'- �t?C <br />Owner: �,a,^ d- Hi Mot, f-yr�1aM, Email: <br />Property Address: Owner's Address (if different) <br />Tank Information <br />Reason for Pumping: ❑ Complinace Inspection ❑ Holding Tank 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 good: 1'`s Alarm working: Yes <br />No No No <br />N/A <br />Tank Leakage Observed: Above operating depth Yes o (repairs recommended) <br />Below operting depth Yes o (failing to protect groundwater) <br />Gallons Removed: <br /># I #2 j LX>j> #3 #4 Pump tank Total <br />Disposal Method: Municipal: Q Location: Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />Safety Concerns: 0 on t- <br />Recommended Repairs: vne-i- s C. i,J,t- Iv11 .4" L L <br />Comments: <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 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 />chipseptic@gmaii.com <br />revised 312025 <br />