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Septic Tank Pumping/Maintenance <br />Owner Information <br />Date: rj `�� �-' Phone: <br />Owner: Email: <br />Property Address: Owner's Address (if different) <br />rtv �YtLr\ <br />Qk0 <br />(Reason for Pumping: <br />Method of Access: <br />(Condition of Tanks: <br />Filter Cleaned <br />(Tank Leakage Observed: <br />Gallons Removed: <br />#1 NW #2 <br />(Disposal Method: <br />Safety Concerns: <br />Recommended Repairs: <br />ents: <br />Tank Information <br />❑ Complinace Inspection ❑ Holding Tank 91fMaintenance <br />Qf Manholes ❑ Inspection Pipe (holding tanks only) <br />/ (Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Yes Baffles good: s Alarm working: s <br />No No No No <br />N/A N/A <br />Above operating depth Yes 71 <br />0 (repairs recommended) <br />Below operting depth Yes/co (failing to protect groundwater) <br />#3 #4 Pump tank ?:!� D Total ,� 3- o <br />Municipal: Q Location: Watertown Wastewater Facili <br />Land Applied: ❑ 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 system per omance 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@gmail.com <br />revised 312025 <br />