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Ende Septic Service, LLC <br />24910 Territorial Road - Rogers, MN 55374 <br />Phone: 763-428-4489 - e-mail: info (cD,endeseptic.com <br />MPCA License #: L2654 <br />Date: ! % <br />Invoice <br />Reason for Pumping: Na i o� , <br />Pumping fee: <br />Volume pumped: <br />Long pull fee: <br />Name; i. t1,11, l �t <br />Other: <br />Address: ? L a� �� L KD <br />Total Cost of Service: <br />City/State/Zip: <br />.L4-1 ! '% N <br />Payment Method: <br />❑ Check ❑ Cash ❑ Credit <br />Septic Tanks & System Condition <br />Access: L7 Maintenance Hole <br /># of Tanks: _;> <br />Type of System: M.Pokcf, <br />❑ Other <br />Volume pumped: <br />pH: <br />Risers: N Yes ❑ No <br />Manholes to surface: . <br />System .Watertight: <br />k Yes ❑ No ; <br />[*Yes ❑ No <br />Baffles ❑ Yes ❑ No <br />Effluent screen: <br />Noticeable surfacing: <br />❑ Yes U No <br />❑ Yes IP No <br />Tank Access & Structurally Safe: <br />Tank type:] Precast <br />Ponding: <br />❑ Yes ❑ No <br />0 Cesspool <br />❑ Yes � No <br />Tanks water tight: WYes ❑ No <br />Piping checked: <br />Signs of non-domestic waste: <br />RrYes ❑ No <br />❑ Yes 'T No <br />Length of Pull: (�, (}.,s <br />Pump or Wiring Faulty: <br />Manholes Securely replaced: <br />❑ Yes ZI No <br />V' Yes ❑ No <br />Comments regarding system: <br />Is a mound cleaning recommended at this time: : EN Yes ❑ No <br />------------------------------OFFICE USE ONLY ------------------------------- <br />Disposal: ❑ Land Application ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Gallons: <br />Plowed: : ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: <br />Time: <br />Temperature: <br />pH: <br />