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JIM EICHER <br />1205 LaBeaux Ave. N.E. - St. Michael, MN 55376 <br />Phone: (763) 497-2764 - e-mail: duaneseptic@centurylink.net <br />Septic Servv%ile, LLC MPCA Lic. # 654 <br />Date &I Z/" 17 Statement <br />Pumping Fee:O <br />Name: 11-4f <br />15 ° rt - <br />Long Pull Fee <br />Address: <br />�6Q It 6 <br />Other <br />City/State/Zip: <br />Risers: `Yes El No <br />Manhgto surface: <br />Total Cost of Servi <br />11 1 Z_ <br />-----Septic Tanks & System Condition <br />Access: 2<aintenance Hole <br /># of Tanks: �7 -0 <br />Type of Sysm: <br />0 Other <br />,5-12:5 <br />Volume pumped: <br />Risers: `Yes El No <br />Manhgto surface: <br />Reason For Pumping <br />12'�Yes 0 No <br />Baffles 1514s 0 No <br />Effluent scree <br />;�N <br />Noticeable surOw'Ing: <br />0 Yes <br />El Yes Rf�o <br />Tank Access & Safe: <br />,S�ctt.ally <br />0 No <br />Tank type: Precast <br />Ponding: <br />cs z' <br />0 Cesspool <br />0 Yes <br />Tanks water tight: : ET"Yes 11 No <br />Piping checke <br />� <br />Signs of non estic waste: <br />em <br />0 Yes 0 <br />0 Yes 2leo <br />Length of Pull- <br />190 <br />r <br />Pump 0 Faulty: <br />WjRKg <br />es Securely replaced: <br />T��T;] Securely <br />0 Yes 11 No <br />es C <br />ONo <br />Comments regarding system: <br />------------------------------OFFICE USE ONLY ------------------------------- <br />Disposal: 0 Land Application 0 Wastewater Treatment Plant <br />Disposal Site: Lime: Gallons: Plowed: : 0 Yes 0 No <br />Time: Temperature: pH: <br />Time: Temperature: pH: <br />