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DUANE BARTHEL <br /> tib <br /> ., 1205 LaBeaux Ave.N.E. •St.Michael,MN 55376 <br /> DUA IS Phone:(763)497-2764•e-mail:duaneseptic@centurylink.net <br /> Septic Service, LLC MPCA Lic.#654 <br /> Date 9--2 7- 19 Statement <br /> Pumping Fee:4: <br /> 3� •.-g Ni�nne: <br /> Long Pull Fee: llrivb <br /> Other $...,,,.....•------ Ci fState/Zipi <br /> .avl c...4.. <br /> Total Cost of Service I. o ..p <br /> �/�� Septic Tanks&System Condition <br /> Access: Matntenance Hole #of Tanks: <br /> l7Type of System: <br /> OOther Volume pumped: 0 tkek <br /> Risers: CJ Yes 0 Nolto surface: Reason For Pumping <br /> el Yom 0 No yvtLt.okf. <br /> Baffles Q Yes 0 No Effluent scr st Noticeable surfacing: <br /> O Yes CrNo 0 Yes C31Vo <br /> Tank Access& tructurally Safe: Tank type: H1rrecast Ponding: <br /> t'Yes O No/ 0 Cesspool D Yes <br /> Tanks water tight: : Yes 0 No Piping check' Signs ofnon-domestic waste: <br /> DYes Mai No OYes Ol o <br /> Length of Pull: t Pump or Winjg Faulty: Manholes Securely replaced: <br /> 1 S D Yes l 1io 8ofes ❑No <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 /> ..40 <br /> .-.t '' 1 L.4 A It al .-,' THANKS <br /> Air <br /> ,.,/ `` "''✓„ mss - ~'♦'' <br />