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4 - DUANE BARTHEL <br /> . tr <br /> 1205 LaBeaux Ave. N.E. •St. Michael,MN 55376 <br /> D„fat) <br /> ukS Phone:(763)497-2764•e-mail:duaneseptic@centurylink.net <br /> Septic Service, LLC MPCA Lic.#654 <br /> Date ^/2 -76 Statement <br /> Pumping Fee: Name: <br /> 3--s- <br /> Long Pull Fee: Address., 7s,•, illeed <br /> Other City/State/Zip: ' <br /> Total Cost of Service <br /> Septic Tanks&System Condition <br /> Access: 0 Maintenance Hole #of Tanks:2—/ao� A Type of System: <br /> 0 Other Volume pumped: rT�'4// <br /> Risers: 0 Yes 0 No Manholes to surface: System Watertight: <br /> ❑Yes ❑No ❑Yes ❑No <br /> Baffles 0 Yes 0 No Effluent screen: Noticeable surfacing: <br /> ❑Yes ❑No ❑Yes ❑No <br /> Tank Access&Structurally Safe: Tank type: 0 Precast Ponding: <br /> ❑Yes 0 No 0 Cesspool 0 Yes 0 No <br /> Tanks water tight: : 0 Yes 0 No Piping checked: Signs of non-domestic waste: <br /> ❑Yes ❑No ❑Yes ❑No <br /> Length of Pull: Pump or Wiring Faulty: Manholes Securely replaced: <br /> ❑Yes ❑No ❑Yes ❑No <br /> Comments regarding system: <br /> OFFICE USE ONLY <br /> Disposal: 0 Land Application 0 Wastewater Treatment Plant <br /> Disposal Site: Lime: Gallons: Plowed: : 0 Yes 0 No <br /> Time: Temperature: pH: <br /> Time: Temperature: pH: <br /> c • j c . THANKS <br /> Q <br />