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Septic Tank Pumping/Maintenance DELIVERED NOV 0 3 2025 <br />Owner: pnn plikea.-<ayt <br />Property Address: <br />s � inw ss Ye�L <br />Owner Information <br />Tank Information <br />Phone: y5a - <br />Emai 1: <br />Owner's Address (if different) <br />Reason for Pumping: ❑ Complinace Inspection ❑ Holding Tank 0 Maintenance <br />Method of Access: <br />Manholes <br />❑ 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 />Y�s Baffles good: <br />Y�s Alarm workings <br />No <br />No <br />No <br />N/A <br />N/A <br />N/A <br />Tank Leakage Observed: <br />Above operating depth <br />Yes (repairs recommended) <br />Below operting depth <br />Yes o (failing to protect groundwater) <br />Gallons Removed: <br />#1 /()pQ #2 /D,)p #3 <br />#4 <br />Pump tank W Total <br />Disposal Method: Municipal: <br />Q <br />Location: Watertown Wastewater Facility <br />Land Applied: <br />❑ <br />Location: <br />(Safety Concerns: <br />Recommended Repairs: <br />(Comments: lJ,,,,,,,,n -< ueA.,-c ' <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 per om nce has been nor can be made. <br />Chip's Septic Service, LLC & SSTS <br />-'artzer's Sewer Services License <br />62 Babcock Avenue Maintaner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipseptic@gmail.com <br />revised 312025 <br />