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Septic Tank Pumping/Maintenance <br />Owner Information <br />Date:r` _ <br />� ' �,� Phone: <br />Owner: c� <br />�G:C�T� d' ��� I1�,Y� _y�N�a�' Email: <br />Property Address: Owner's Address (if different) <br />n,� <br />(Reason for Pumping: <br />Method of Access: <br />Condition of Tanks: <br />Filter Cleaned <br />ank Leakage Observed: <br />Gallons Removed: <br /># 1 /L-W� #2 <br />Method: <br />Safety Concerns: <br />Recommended Repairs: <br />Comments: <br />Tank Information <br />❑ Complinace Inspection ❑ Holding Tank P(Maintenance <br />Q'Manholes ❑ Inspection Pipe (holding tanks only) <br />/ (Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Yes Baffles good <br />No <br />Above operating depth <br />Below operting depth <br />e�,o #3 #4 <br />Municipal: <br />Land Applied: <br />G-- — <br />3 <br />Y/ Alarm working: >e <br />No No <br />N/A N/A <br />Yes (repairs recommended) <br />YesIX (failing to protect groundwater) <br />Pump tank ,�"L ' Total , t <br />Q Location: Watertown Wastewater Facility <br />❑ Location: <br />MA <br />I hereby certify that 1 have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No determination or guarantee offuture s r vmance 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 />