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9-13-24 SSTS abandonment Form
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215 North Arm Lane - 06-117-23-24-0001/2
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9-13-24 SSTS abandonment Form
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Last modified
10/1/2024 8:30:15 AM
Creation date
10/1/2024 8:30:03 AM
Metadata
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Template:
x Address Old
House Number
215
Street Name
North Arm
Street Type
Lane
Document Type
Septic
PIN
215
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R ESIDEN'FIAL & COMMERCIAL <br />%%J RAC <br />SEWER •SEPTIC •EXCAVATING <br />Kothrade SWE, Inc. <br />P.O. Box 210 ° Hanover, MN 55341 <br />763-498-8702 • www,kothrade.com <br />Work Order/Invoice <br />30405 <br />4 C,- <br />Billing: ��' I S' d ; , Time In: Time Out: <br />Job Site: 0✓ Aim <br />P.O. # <br />Phone: Recommended Service Date: <br />Ot . <br />Item <br />Parts <br />Labor <br />Other <br />Qty. <br />Item <br />Parts <br />Labor <br />Other <br />MISCELLANEOUS <br />LINE CLEANING <br />Service Call/Trip Charge <br />Service Call <br />Tank Compliance Inspection <br />Jetting <br />Truck to Hourly Charge <br />Televising <br />Overtime Charge <br />Main Line (First 50 feet) <br />Flat Rate Fee <br />Additional Footage <br />TANK CLEANING <br />Floor Drain <br />Maintenance Hole Exposed ❑'Yes ❑ No <br />Laundry Line <br />Tanks ❑ 1 P12 ❑ 3 ❑ 4 <br />Kitchen Line <br />Tank Size ' �,7,- <br />:?1/� `�;. <br />Bathroom Line <br />Disposal <br />Miscellaneous Line <br />City Permit <br />Toilet/Urinal Remove/Replace <br />Extra Hose <br />Snake Toilet/Urinal <br />Extra Gallons <br />Sanitizing <br />Extra Back -flushing <br />Parts/Materials <br />Extra Labor <br />Labor <br />Commercial Pumping <br />PUMP REPLACEMENT <br />Sand Disposal <br />Service Call <br />Commercial Waste Transport <br />Digging ❑ Hand ❑ Backhoe <br />RAISING MAINTENANCE HOLE <br />Lift/Sump Pump <br />Service Call <br />Electrical Hardware <br />Digging ❑ Hand ❑ Backhoe <br />Float Switch <br />Riser ❑ Concrete ❑ Plastic <br />Alarm <br />Maintenance Hole Cover <br />Parts/Materials <br />Adjustment Ring <br />Pump Disposal <br />Pipe & Caps <br />Labor <br />Tar & Cement <br />BAFFLE <br />Materials <br />Service Call <br />Cement Disposal <br />Confined Space Entry <br />Delivery Charge <br />Materials <br />Labor <br />Labor <br />Estimates by Kothrade Sewer, Water &Excavating, Inc. ("Kothrade") are based on facts made <br />known to Kothrade as of the date of the estimate, and therefore are subject to change. Costs of <br />labor and materials may vary after the work commences based on unforeseen issues, including <br />, <br />but not limited to, acts or omissions of Customer or third parties or job side conditions. In the <br />event Kothrade determines additional work or materials are necessary, and the cost will exceed <br />the original estimate, Kothrade will seek Customer approval prior to commencing with the <br />additional and/or necessary work. If the Customer is unavailable or cannot be reached, and the <br />work must be completed due to circumstances, Kothrade, in its sole discretion, may complete <br />the work, and Customer shall be responsible for all services, labor and materials used. <br />I authorize and agree to pay Kothrade for the services, labor and materials as itemized & <br />described above. I <br />TOTAL PARTS <br />TOTAL <br />TOTAL OTHER CHARGES �- <br />SALES TAX <br />AND TOTALOf`` " <br />❑ CHECK El CASH ❑ ON ACCOUNT ElMC-VISA-DISC <br />Customer Signature Kothrade SWE� Inc. Technician <br />Date <br />Customer Signature Kothrade SWE� Inc. Technician <br />Date <br />
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