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Septic Tank Pump ing/Maintenance <br />Owner Information <br />Date: ? - 6 _ 25' Phone: 4�42-,&tZ - !Yf2yG <br />Owner: 1-e � CAL + l�-�c] Email: <br />Property Address: Owner's Address (if different) <br />VYo 5�wbh5 �� Rd <br />—r-xbh10 MN Knl cl <br />Tank Information <br />Reason for Pumping: '0 Complinace Inspection ❑ Holding Tank ❑ Maintenance <br />Method of Access: 0 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 XX Baffles good: Alarm working: Vs <br />No No No <br />N/A N/A N/A <br />Tank Leakage Observed: Above operating depth <br />Below operting depth <br />Gallons Removed: <br />#1 / Uv #2 / oU #3 #4 <br />Disposal Method.: Municipal: Q <br />Land Applied: ❑ <br />Safety Concerns: <br />lRecommended Repairs: <br />IComments: <br />Yesy (repairs recommended) <br />Yes/o (failing to protect groundwater) <br />tank <br />Total <br />Location: Watertown Wastewater Facil <br />Location: <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 of future system verfomance 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@tzmaii.com <br />tzmail.com <br />revised 312025 <br />