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Septic Tank Pumping/Maintenance <br />Owner Information <br />Date: Ci-(b^g-s Phone: <br />Email: <br />ty Address: J Owner's Address (if different) <br />aaNs c &L,- . A.. <br />Tank Information <br />Reason for Pumping: ❑ Complinace Inspection ❑ Holding Tank Maintenance <br />tea, je j f k _f_,," a l-1cr p �,,.P,.•� <br />Method of Access: Qf 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: Ya Alarm working: Yes <br />No No No <br />r N/A VA <br />Tank Leakage Observed: Above operating depth Yes (repairs recommended) <br />Below operting depth Yes (failing to protect groundwater) <br />Gallons Removed: <br />#1 v #2 %?rp #3 #4 Pump tank UV Total yljoo <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 1 have completed this work in accordance with MN 7083.0770 and any local requirements. <br />No determination or guarantee offuture system performance 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&gmail.com <br />revised 312025 <br />