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Septic Tank Pumping/Maintenan&LIVERED NOV 19 2025 <br />Owner Information <br />Phone: c1z,/e2 -394Q -,?OIL <br />Owner: A1 yl-;I� e,'11te Email: <br />Property Address: Owner's Address (if different) <br />3 yoS A�04 L.n <br />Oro /nn/ r-6725te <br />Tank Information <br />Reason for Pumping: ❑ Complinace Inspection ❑ Holding Tank ff Maintenance <br />Method of Access: <br />Condition of Tanks: <br />Filter Cleaned <br />Tank Leakage Observed: <br />Gallons Removed: <br />#1 /~VN #2 <br />(Disposal Method: <br />Safety Concerns: <br />lRecommended Repairs: <br />[Comments: <br />Manholes ❑ Inspection Pipe (holding tanks only) <br />(Owner's signature req'd if refusing to allow pumping through maintenance hole) <br />Yes Baffles good <br />No <br />Above operating depth <br />Below operting depth <br />#3 <br />Municipal: <br />Land Applied: <br />#4 <br />Alarm working: e0l <br />No <br />N/A <br />N/A <br />Yes (repairs recommended) <br />Yes/ o (failing to protect groundwater) <br />tank Total <br />a Location: Watertown Wastewater Faci <br />❑ Location: <br />1 hereby certify that I have completed this work in accordance with AN 7083.0770 and any local requirements. <br />No determination or guarantee ofjuture system perfomance has been nor can be made. <br />Chip's Septic Service, LLC & SSTS <br />artzer's Sewer Services License <br />'ro762 Babcock Avenue Maintaner Signature #2064 <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chipseptic@gmail.com <br />revised 312025 <br />