Laserfiche WebLink
Septic Tank Pumping/Maintenance <br />Owner Information <br />Date: (9, 12 - al�; Phone: - - <br />Owner: j V- Mass a ��1G¢Y Email: <br />Property Address: Owner's Address (if different) <br />O7r •wr't, <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: o <br />Filter Cleaned Yes Baffles good: es Alarm working: �s <br />No No No <br />- N/A N/A <br />Tank Leakage Observed: Above operating depth Yes o (repairs recommended) <br />Below operting depth Yes (failing to protect groundwater) <br />Gallons Removed: <br /># I 16jo #2 AA#3 #4 Pump tank Total X� <br />Disposal Method: Municipal: Q Location: Watertown Wastewater. Facility <br />Land Applied: ❑ Location: — <br />Safety Concerns: <br />Recommended Repairs: <br />Comments: <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 offuture system per omance has been nor can be made. <br />SSTS <br />Lice <br />Chip's Septic Service, LLC & <br />Swartzer's Sewer Services License <br />Maintaner Signature #2064 <br />16762 .Babcock Avenue <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipseptic agmail.com <br />revised 312025 <br />