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Septic Tank Pumping/Maintenance <br />Owner Information <br />Date: f/./-Z Phone: Z— 0 eT Z 7 0 <br />Owner: �j' fT e C=�/��g Email: <br />�r0p��t flddress; I U )italllLwn ij Owner's Address (if different) <br />Tank Information <br />Reason for Pumping: ❑ Compl i nace i nspecti on ❑ Holding Tank ( t�Pofaaintenance <br />Method of Access: anho Ins Q'1� es i ❑ Inspection p Pipe (holding tanks only) <br />(Owmer's signature rey d if refusing to allow pumping through maintenance hole) <br />Condition of Tanks: <br />Filter Cleaned <br />(Tank Leakage Observed: <br />Gallons Removed: <br />##1 /f)nh #2 166 A #3 <br />Yes Bafflcs good; <br />No <br />NJ <br />Above operating depth <br />Below operting depth <br />(Disposal Method: Municipal: <br />Land Applied: <br />'Safety Concerns: <br />lRecommended Repairs: <br />(Comments: <br />#4 <br />cs Alarm working: (n!) <br />No No <br />N/A N/A <br />YC (repairs recommended) <br />YeC> (failing to protect groundwater) <br />tank <br />Total <br />Q Location: Watertown Wastewater Facili <br />❑ Location: <br />R"M <br />L <br />0tk.J' -- ILTn Eta-.,W -I- )', kJ 4/1 use-h -- ( 4-, 1 <br />1 hereky certij� that I have completed this work itt accordance with MN 7083.0770 and aiiy local requirements. <br />No determination or guarantee of future syst anu 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 />chijseptic ,gtnail.com <br />r"iald 312025 <br />