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Septic Tank Pump ing/Maintenance <br />Owner Information <br />Date: %aZ. ` d� Phone: 7 . , - �C�Y - (kq 1n1. <br />Owner: 4Y„ vuu 04-,L jL -Qej Email: <br />Property Address: Owner's Address (if different) <br />Tank Information <br />Reason for Pumping: ❑ Complinace Inspection ❑ Holding Tank 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 Y/s Baffles good: )I's Alarm working: 4s <br />No No No <br />N/A N/A N/A <br />Tank Leakage Observed: Above operating depth Yes (repairs recommended) <br />Below operting depth Yes/I�o (failing to protect groundwater) <br />Gallons Removed: //// <br /># 1 . <br />tJ #2 /�� #3 #4 Pump tank Total �04> <br />Disposal Method: Municipal: Q Location: Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />(Safety Concerns: <br />Recommended Repairs: <br />(Comments: <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 License <br />16762 Babcock Avenue aintaner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipseptic@jzmail.com <br />revised 312025 <br />