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Septic rank Pumping/Maintenance <br />Owner Information <br />Date: s� 277% 7-5- <br />Owner: 17lG i IP, -1411 I t a` SL'� <br />Property Address: <br />2=0.19- <br />Aron v <br />Tank Information <br />Phone: (y/ Z- - <br />Email: <br />Z- CS" <br />Owner's Address (if different) <br />Reason for Pumping: ❑ Complinace Inspection ❑ Holding Tank Maintenance <br />Method of Access: Q-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 Yes Baffles good: y Alarm working: <br />No No No <br />NUK- N/A N/A <br />Tank Leakage Observed: Above operating depth Y*S( <br />repairs recommended) <br />Below operting depth Yfailing to protect groundwater) <br />Gallons Removed: <br /># 1 #2 #3 #4 Pump tank Total <br />Disposal Method: Municipal: Q Location: Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />Safety Concerns: 44,-ou-J l r le- l,'^ul i ^ A 0L P -A, <br />(Recommended Repairs: /-�„ 91,S-6 <br />(Comments: i-1,1. H-,o <br />1 hereby certify that I have completed this work in accordance with M1V 7083.0770 and any local requirements. <br />No determination or guarantee of future system ante 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(2amail.com <br />revised 312025 <br />