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Septic Tank Pumping/Maintenance DELIVERED NOV 0 3 2025 <br />Owner Information <br />Date: _23_ ,2S Phone: 790 - Rd <br />Owner: wock l ��-���-� Email: <br />Property Address: Owner's Address (if different) <br />mru <br />for Pumping: <br />Method of Access: <br />Condition of Tanks: <br />Filter Cleaned <br />Tank Leakage Observed: <br />Gallons Removed: <br />cA4^ I <br /># 1 /n,,,, #2 <br />Disposal Method: <br />Safety Concerns: <br />Tank Information <br />❑ Complinace Inspection ❑ Holding Tank A Maintenance <br />0 Manholes ❑ Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />YVs Baffles good: Alarm working: Y <br />No 4os <br />No <br />N/A N/A N/A <br />Above operating depth Yes/I)l6 (repairs recommended) <br />Below operting depth Yes (failing to protect groundwater) <br />ch..P,d c&b,ti, e-«5e., <br />¢vo #3 /ovv #4 <br />Municipal: Q Location: <br />Land Applied: ❑ Location: <br />Recommended Repairs: <br />Comments: <br />tank /Guy Total ��Ud <br />Watertown Wastewater Facilitv <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, MN. 55354 <br />(952) 200-3176 <br />chipseptic2amail.com <br />revised 312025 <br />