! Valid from: Jan.1 to Dec.31, 2015 ! R. Rogers Septic LLC. nd 401 NE 52 Ave., Des Moines, IA 50313 Septic Service Maintenance Agreement (MA) Owner Name: ____________________________________Email:____________________________________ Address of Property: _______________________________City, Zip: __________________County:_________ Billing Address: ____________________________________________________________________________ Home Phone: _________________________________Cell Phone: ___________________________________ Peat Filter Type, circle yours: Eco Flo Peat, Eco Pure Peat, other: ____________ _ Rogers Septic proposes to offer a service maintenance agreement on the septic system at the property listed above. The cost of the contract is $250.00 with one water sample. If a sample is not required by the County Health Department, the cost is $200.00. Contact your county health department regarding this issue. If you have more than 1 peat filter on property add $75.00 for each additional filter. WARREN Co. & BOONE Co. require two water sample, one in spring, and one in fall. If your located in these counties or request 2 water samples ADD $85 for fall water sample. A copy of this agreement, MA report, & water samples will be sent to the county health department. The MA consist of : • Spring / fall (?) water samples. If not discharging a no discharge form will be sent to county • Check water level and sludge level in septic tank. • Clean effluent filter once a year. • Check and adjust water distribution system over top of peat • Rake and check peat moss • Check / Test electric components (Alarm system, UV Lite system, Lift pumps) • Clean outlet discharge pipe (approx. 2-3ft of end if accessible) Cost of non-contract service. Homeowner authorization required. • Cleaning septic tank: $250.00 (plus disposal fee $85.00 per 1,000 gallons). • Any repairs to septic system. Time & material. • Peat replacement. Cost to be quoted This contract is renewable yearly for the life of the system. This contract does not hold the contractor liable for any malfunctions of the system. PLEASE COMPLETE, SIGN, AND RETURN WITH PAYMENT to above address, and check payable to R Rogers LLC. ,or credit card info below. MC / Visa #s________________________________ exp. ______________ 3 digits code on back___________ Amount $________________________________ Contract accepted (owners signature)____________________________________________Date:_____________________________ By signing this contract, you are authorizing payment and Rogers Septic (R Rogers LLC) access to your property, to preform required maintenance to your septic system and to remain in compliance with the Iowa DNR chapter 69.
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