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Septic Tank Pumping/Maintenance <br />Date: s2- 2 7 ,L�t`' <br />Owner: <br />Property Address: <br />-z2ta�>�icG,.t� r^ <br />(Reason for Pumping: <br />Method of Access: <br />(Condition of Tanks: <br />Filter Cleaned <br />(Tank Leakage Observed: <br />Gallons Removed: <br />#1 1 iJni-) #2 <br />(Disposal Method: <br />Safety Concerns: <br />(Recommended Repairs: <br />Comments: <br />Owner Information <br />Phone: %a--_ NSASy <br />Email: on cl-Dl <br />Owner's Address (if different) <br />Tank Information <br />❑ Complinace Inspection <br />❑ Holding Tank Maintenance <br />[Manholes <br />❑ Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Yes Baffles good: <br />)Pe's Alarm working: Yes <br />No <br />No No <br />Y" <br />N/A <br />Above operating depth <br />Y (repairs recommended) <br />Below operting depth <br />Yes o failing to protect groundwater) <br />#3 #4 <br />tank <br />Total <br />Municipal: Q Location: Watertown Wastewater Facili <br />Land Applied: ❑ Location: <br />Wn <br />I 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 —<7License <br />16762 Babcock Avenue Maintaner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipseptic(2gmail.com <br />revised 312025 <br />