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Septic Tank Pumping/Maintenance 6Z&r,sU <br />Owner Information <br />Date: '1 ��,'' <br />a Phone: 7�.3 <br />Owner: <br />Email: <br />Property Address: Owner's Address (if different) <br />'70 l.J e c r• I -n <br />Or-dw-),z, NIMN �-Z3 co <br />Reason for Pumping: <br />Method of Access: <br />of Tanks: <br />Filter Cleaned <br />Tank Leakage Observed: <br />Gallons Removed: <br /># 1 / 2Z-3/) #2 <br />Method: <br />Safety Concerns: <br />Recommended Repairs: <br />Comments: <br />Tank Information <br />❑ Complinace Inspection ❑ Holding Tank emaintenance <br />Manholes ❑ Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Y�s Baffles good: s Alarm working: s <br />No No zo <br />N/A N/A N/A <br />Above operating depth Yes /( (repairs recommended) <br />Below operting depth Ye 0 <br />(failing to protect groundwater) <br />#3 #4 <br />Municipal: <br />Land Applied: <br />Q Location: <br />❑ Location: <br />tank <br />Total , S(,� <br />Watertown Wastewater Facili <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 system er 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 />chipsepticAjzmail.com <br />revised 312025 <br />