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Septic 'rank Pumping/Maintenance <br />Owner Information <br />Date: Z� 3 Phone: <br />Owner: 177)"c . S'�{ �� Email: <br />Property Address: Owner's Address (if different) <br />Tank Information <br />Reason for Pumping: ❑ Complinace Inspection ❑ Holding Tank 0-maintenance <br />Method of Access: [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 <br />Tank Leakage Observed: <br />Gallons Removed: <br />Yes Baffles good: <br />No <br />Above operating depth <br />Below operting depth <br />1 /M (I #2 %hn t) #3 #4 <br />(Disposal Method.: <br />Safety Concerns: <br />(Recommended Repairs: <br />(Comments: <br />Municipal: <br />Land Applied: <br />es Alarm working: Yes <br />No No <br />N/A (2� <br />Yes/No (repairs recommended) <br />Yes/No (failing to protect groundwater) <br />Pump tank 5D0 Total 2,57C%' <br />Q Location: Watertown Wastewater Facility <br />❑ Location: <br />0 <br />1 hereby certify that I have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No determination or guarantee of future system perfomance 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 />chipsepticggmail.com <br />revised 312025 <br />