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Septic Tank Pumping/Maintenance <br />Owner Information <br />Date: air _ Phone: l2fl,; - 7U I 7c <br />Owner: (j-.rprs -� AsAtcu me;r— Email: <br />Property Address: nLJ Owner's Address (if different) <br />dy;? r nr �A� �ivr� �►/1 _ <br />62ro.,o M/V s'KZ(. <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: s Alarm working: Vs <br />No No 0 <br />INK <br />N/A N/A <br />Tank Leakage Observed: Above operating depth YesX,) (repairs recommended) <br />Below operting depth Yes/yo (failing to protect groundwater) <br />Gallons Removed: <br /># 1 /3UU #2 /,?oo #3 #4 Pump tank 7C0 Total 106-0 <br />Disposal Method: Municipal: Q Location: Watertown Wastewater Facility <br />Land Applied: ❑ Location: <br />Safety Concerns: <br />lRecommended Repairs: <br />(Comments: <br />1 hereby certify that 1 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 Maintaner Signature #2064 <br />Lester Prairie, NIN. 55354 <br />(952) 200-3176 <br />chipseptic �gmail.com <br />revised 312025 <br />