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, 5-i 7 s,at.60_,(4 ,4e,v9 , ,i,
<br /> II
<br /> �� ,� NE BARTHEL
<br /> \ �
<br /> 120S,La8eau
<br /> Du � P„,‘:,:4-:°,-064,31
<br /> onp,` 4 497-27 e.N E •St.Michael,MN 55376
<br /> Septic.S@ , e-mail:duaneseptic@centurylink.net
<br /> P rvice, LLC°.7
<br /> -ti, ., MPGA he #654
<br /> Date ,.-1-4,°"v.--,*
<br /> * a+». •...--*7--1" 7"n,',, ,,,,- € r,. #:
<br /> Pumping Fee .,„1.
<br /> , � 5 menet
<br /> Long t4'
<br /> Pull F ` a � " ,a _ L— '.`
<br /> Address .
<br /> Other ` '
<br /> A0Z � 3n1 ;� i 'r1, a. a ,' W .4.'_�
<br /> ai7
<br /> •tiler °' „ l° q Type of Systett ,,---1,-.„
<br /> -i" 1
<br /> �W. k1r,�'11!�-&fir,.." �, �'�° 4... .4.-.,s � `�,
<br /> i Yes ❑N ,.ta r �.i `'
<br /> �, 1 `,.'•es tQONo Lti,•� r
<br /> • 0 Yes 0 No
<br /> i �Ves ❑No '
<br /> Effluent screen: I Noticeable surfacing:
<br /> 0 yes ❑No ❑Yes ❑No
<br /> Access&Structurally Safe:
<br /> 0 Yes 0 No I Tank type: 0 Precast I Ponding:
<br /> "` ti ❑Yes0 Cesspool ❑Yes 0 No
<br /> ." $1!t: 0 No I Piping checked: Si
<br /> :,--.`)P1---. ., � .
<br /> _. Signs of non-domestic waste:
<br /> ❑Yes 0N ❑Yes 0N
<br /> Length of Pull: .
<br /> Pump or Wiring Faulty: I Manholes Securely replaced
<br /> 0 Yes No ❑Yes ❑No „`
<br /> Comments regarding system: `
<br /> - -----------------OFFICE USE ONLY "r1.i'
<br /> Disposal: 0 Land Application , ❑Wastewater Treatment Plant ' i''-'-ko,',1`•,,,9•Ar*.l#:V
<br /> Disposal Site: lime: Gallons: . � E'
<br /> Plowed II ,-a„; ,,.
<br /> J,, Temperature: pH„ �`
<br /> •
<br /> ;, Temperature: £
<br /> 0'.- cam' dg ,...J, "Q . ---'illfrdikj 1 0 i.A 7 ' iiilp , ‘,.-pa___Y „, _,
<br />
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