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Septic Tank Pumping/Maintenance <br />Owner Information <br />Date: 5-91l Phone: <br />Owner: 11__ n�_J! Its Email: <br />Property Address: _ �/� Owner's Address (if different) <br />ll <br />(Reason for Pumping: <br />Method of Access: <br />Condition of Tanks: <br />Filter Cleaned <br />Tank Information <br />❑ Complinace Inspection ❑ Holding Tank 01,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: /es Alarm working: V,4 <br />No No No <br />N/A N/A <br />Tank Leakage Observed: Above operating depth <br />Below operting depth <br />Gallons Removed: <br /># 1 (j,p #2 %ocX,? #3 #4 <br />(Disposal Method: Municipal: 0 <br />Land Applied: ❑ <br />Safety Concerns: <br />Yes/I,/ (repairs recommended) <br />Yes/t�6 (failing to protect groundwater) <br />tank <br />Total <br />Location: Watertown Wastewater Facili <br />Location: <br />Recommended Repairs: _ ,� �-- fS.t� 6Aj j r4+ I- -� .-j <br />Comments: ow�-- <br />1 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@amail.com <br />revised 312025 <br />