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�r1 11Ende Septic Service, LLC <br /> \fp-i 24910 Territorial Road • Rogers, MN 55374 <br /> Ill � Phone: 763-428-4489 • e-mail: info(irb,,endeseptic.com <br /> -- ._ MPCA License #: L2654 <br /> Date: , — )- y —/ `P Invoice <br /> Reason for Pumping: (, e�,'�,�;,, y Pumping fee: 3 S 0 <br /> Long pull fee: <br /> Name:Z hifdeV 4lit4 e 5 Other: <br /> Address: )U C () FC) <br /> k tS-I. Total Cost of Service: 3 50 <br /> City/State/Zip:0 Payment Method: <br /> /OA& iciv ./J• ❑ Check ❑ Cash ❑ Credit <br /> r <br /> Septic Tanks & System Condition <br /> Access: L'Maintenance Hole # of Tanks: j Type off;System: <br /> ❑ Other Volume pumped: ow m, .nd <br /> Risers: (1:l Yes ❑ No Ma poles to surface: S stem Watertight: <br /> IA Yes O No Yes D No <br /> Baffles KYes ❑ No Effluent scr en: Noticeable s facing: <br /> ❑ Yes I No ❑ Yes No <br /> Tank Acce & Structurally Safe: Tank type: Precast Ponding: <br /> 611 Yes ❑ No ❑ Cesspool O Yes iNo <br /> Tanks water tight: : jYes ❑ No Pi ng checked: Signs of no -domestic waste: <br /> Yes Nl No ❑ Yes ® No <br /> Length of Pull: \ r Pu/np or Wiring Faul : M� holes Securely replaced: <br /> Yes ❑ Nc4J , ww L Yes ❑ No <br /> Comments regarding system: )(kb) 5 y J tot <br /> ?Lii--,c )Sit, '-) Lv4we. tled 1-0 o e✓ re,-f _ <br /> I •e -: _ imen•e• at is ii . . Yies U No <br /> OFFICE USE ONLY <br /> Disposal: E Land Application ❑ Wastewater Treatment Plant <br /> Disposal Site: Gallons: Plowed: : ❑ Yes 0 No <br /> Time: Temperature: pH: <br /> Time: Temperature: pH: <br />