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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />M ATC I . - J/ '7 / <br />Maintenance Inspection Form <br />MPCA Lie. # 654 <br />Maintalner D Jim <br />zDuane <br />ick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic(gcenturylink.net <br />INVOICE <br />Pumping Fee: <br />N�P ('L <br />, <br />�- JJ <br />) Vim_ �✓ , v. <br />-� h <br />Long Pull Fee: <br />O' <br />' <br />,rr�,�t I <br />Address: <br />O :EL_.' V\'tw. <br />`�`? <br />ther Repair <br />City/State/Zip: <br />J�j[Total <br />a,� <br />X1-0 �o <br />Cost of Service- <br />��� <br />Payment Method: ❑ Check <br />❑ Cash <br />❑ Credit <br />T Ll <br />Maintenance hole cover is damaged, <br />Tank leaks below the <br />Tank leaks above the <br />cracked, unsecured, or appears to be <br />Tank (check if present) <br />designed operating depth <br />designed operating depth <br />structurally <br />unsound <br />otic/holding Tank #10 <br />Yes <br />❑Yes filo <br />❑Yes ❑�^ <br />p� oo <br />Gallons: Z SD <br />peptic/holding Tank #2 <br />❑ Yes O'No <br />❑ Yes Er -93- <br />❑ Yes <br />9>a <br />Gallons: l ZS -L-> <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />9-f 21-0 'mp Tank <br />❑ Yes Cr -No <br />❑ Yes CNo <br />❑ Yes <br />Gallons: i 2try <br />How Accessed: aintenance Hole Scum/Sludge Measured-fdo i Mainte�nan�ce Holes Securely Replaced: Reason For Pumpin <br />❑ Other (see attached) ❑ Yes ❑" es ❑ No T-Vk0' _ <br />Did you identify any operational issues or unsafe conditlons while assessing the sewage tanks In this system, I.e., <br />c cked tanks, missing baffles, broken covers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes o Tank #2 ❑ Yes o Pump Tank ❑ Yes 2rNo System i <br />❑ Structural integrity ❑ Structural integrity ❑ Structural Integrity ound I <br />❑ Risers leaking ❑Risers leaking ❑ Elevated drain <br />❑ Risers leaking g ! <br />❑ Baffles ❑ Baffles ❑ Battles ❑Pressure bed <br />❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical Issues ❑ Trenches <br />❑ Non-domestic waste ❑ PondinglSurtacing <br />❑ Effluent Filter/screen ❑ Other: <br />_L Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: Gallons Plowed: ❑ Yes C <br />Time; Temperature: pH: <br />Time: Temperature; pH: <br />