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twi�� Ende Septic Service, LLC <br /> �' �� 24910 Territorial Road • Rogers, MN 55374 <br /> `\1 Iii Phone: 763-428-4489 • e-mail: info(c7endeseptic.com <br /> '" - MPCA License #: L2654 <br /> Date: `,l, — )- )- `�—' Invoice <br /> Reason for Pumping: vierxiA cx Pumping fee: 3 S 0 <br /> Long pull fee: <br /> Name:Z h el de,l- e 5 Other: <br /> Address: )6 (f, 9 fc , to. Total Cost of Service: 3 5 0 <br /> City/State/Zip:0 Payment Method: <br /> foiA6 KA .Q, ❑ Check ❑ Cash ❑ Credit <br /> Septic Tanks & System Condition <br /> ' <br /> Access: E'Maintenance Hole # of Tanks: / Type o System: <br /> ❑ Other Volume pumped:I,(jam j I�'�. `n J <br /> Risers: Z Yes ❑ No Ma?)oles to surface: S stem Watertight: <br /> C6 Yes ❑ No ] Yes El No <br /> Baffles Yes ❑ No Effluent sc. Fr en: Noticeable st acing: <br /> ❑ Yes C04:No ❑ Yes No <br /> Tank Acce & Structurally Safe: Tank type: [. Precast Ponding: <br /> Yes ❑ No ❑ Cesspool ❑ Yes iNo <br /> Tanks water tight: : jYes ❑ No Pi ng checked: Signs of no -domestic waste: <br /> Yes Eil No ❑ Yes ® No <br /> Length of Pull: N. l Pu ip or Wiring Faul�: M9tiholes Securely replaced: <br /> (.... A Yes ❑ NA,' 'o,,,, Yes ❑ No <br /> Comments regarding system: ,Q 5 y J tQL __.- <br /> v-I-1 ' <br /> �h f <br /> c r;) re-f <br /> ,,,k-- <br /> _l. � �t��tiL'cf��� �J d j�� e� / � <br /> I ••e_ •e -• . _ - oinmensea a is in . . _es ■ i'o <br /> OFFICE USE ONLY <br /> Disposal: 0 Land Application ❑ Wastewater Treatment Plant <br /> Disposal Site: Gallons: Plowed: : 0 Yes ❑ No <br /> Time: Temperature: pH: <br /> Time: Temperature: pH: <br />