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Septic Tank Pumping/Maintenance <br />62/jAI) <br />Owner Information <br />Date: �- q - - Phone: 9 j a,- r2/6- _ G$t <br />Owner: �,/,'L�� �Email: <br />Property Address: r Owner's Address (if different) <br />6-60 fax IC) 2V11 723Y 1400 3 <br />UJr . 2J'-A-a , /111q _ <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 Y Baffles good: Alarm working: Y/ <br />No No No <br />N/A N/A N/A <br />Tank Leakage Observed: Above operating depth <br />Yes/ <br />(repairs recommended) <br />Below operting depth <br />Yes/ <br />(failing to protect groundwater) <br />Gallons Removed: <br /># 1 /S,00 #2 /,ge�e> <br />#3 #4 <br />Pump tank �� jj Total & '� <br />Disposal Method: <br />Municipal: Q Location: <br />Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />Safety Concerns: <br />4 orl - A)z�rc <br />�'c/�„�, c� <br />rye 500-c�j -- -/2,16 q- <br />Recommended Repairs: <br />1 r lei 2-C -/e.. <br />Y.,, c^le, 2 <br />Comments: <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 of future sy anee 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&gma.il.com <br />revised 312025 <br />