Laserfiche WebLink
JIM EICHER <br />1205 LaBeaux Ave. N. E. • St. Michael, MN 5537.6 <br />p , Phone: (763) 497-2764 • e-mail: duaneseptic@centurylink.net <br />``Septic Service, LLC MPGA Lic. # 654 <br />Date l�'���� 1Zt11tPMP"1 <br />Pumping Fee: <br />Name: <br />Long Pull Fee: <br />Address: •- <br />6;x ..S I� <br />Other <br />City/State/Zip: <br />Risers: ❑ Yes ❑ No <br />Total Cost of Service <br />Septic Tanks & System Condition <br />Access: ❑ Maintenance Hole <br />- <br /># of Tanks: -1-71 (,a"D <br />Type of System: <br />❑ Other <br />Volume pumped: <br />Risers: ❑ Yes ❑ No <br />Manholes to surface: <br />Reason For Pumping <br />❑ Yes ❑ No <br />Baffles ❑ Yes ❑ No <br />Effluent screen: <br />Noticeable surfacing: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Tank Access & Structurally Safe: <br />'rank type: ❑ Precast <br />Ponding: <br />❑ Yes ❑ No <br />❑ Cesspool <br />❑ Yes ❑ No <br />Tanks water tight:: ❑ Yes ❑ No <br />Piping checked`. <br />Signs of non-domestic waste: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Length of Pull: <br />Pump or Wiring Faulty: <br />Manholes Securely replaced: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Comments regarding system: <br />-------------------•--------- OFFICE USE ONLY------------- --------- <br />Disposal: ❑ Land Application ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: Gallons: Plowed: : 0 Yes 0 No <br />Time: Temperature: pH: <br />Time: Temperature: pH: <br />