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Septic 'rank Pumping/Maintenance <br />Owner Information <br />Date: IQ— // - .23— Phone: <br />Owner: 4_C5r1 t"1 i G �r�d�. _ Email: <br />Property Address.- �+ ( Owner's Address (if different) <br />Lq <br />UrCrl1 �. /nail 6 J Su l 2 _ <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 Yes Baffles good: Alarm workings <br />No No 0 <br />N/A N/A <br />Tank Leakage Observed: Above operating depth Yesy (repairs recommended) <br />Below operting depth YesIlWo (failing to protect groundwater) <br />Gallons Removed: <br />#2 #3 #4 Pump tank 06x.) Total'�%� <br />Disposal Method: Municipal: Q Location: Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />Safety Concerns: <br />(Recommended Repairs: r,�t__ mist. risn S -h —k-s <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 mance 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@amail.com <br />revised 312025 <br />