Laserfiche WebLink
Septic Tank Pumping/Maintenance (30-01 1 <br />Owner Information <br />Date: -- - - .. 35 <br />Owner: <br />Property Address: <br />(Reason for Pumping: <br />Method of Access: <br />(Condition of Tanks: <br />Filter Cleaned <br />Tank Leakage Observed: <br />Gallons Removed: <br /># I At D #2 <br />(Disposal Method.: <br />(Safety Concerns: <br />Repairs: <br />Comments: <br />Phone: <br />Email: ` <br />Owner's Address (if different) <br />Tank Information <br />❑ Complinace Inspection ❑ Holding Tank to Maintenance <br />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 />N/A <br />Above operating depth <br />Below operting depth <br />JO #3 #4 <br />Municipal: <br />Land Applied: <br />Y Alarm workings <br />No No <br />N/A N/A <br />Yes /I (repairs recommended) <br />Yes 0 (failing to protect groundwater) <br />tank <br />Total <br />Q Location: Watertown Wastewater F <br />❑ Location: <br />1 hereby certify that I have completed this work in accordance with AM 7083.0770 and any local requirements. <br />No determination or guarantee offuture system nance has been nor can be made. <br />Chip's Septic Service, LLC & SSTS <br />Swartzer's Sewer Services License <br />16762 Babcock Avenue Main aner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipseptic(a), mail.com <br />revised 312025 <br />