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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />1'1ATC 4_. cry i ri <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />D Duane <br />'Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />V v <br />Pumping Fee:2 <br />4 J 's7o 'C -LD <br />Tank #2 ❑ Yes o <br />Name: ( <br />V Gh <br />❑ Structural Integrity <br />❑ Structural integrity <br />Long Pull Fee: <br />l(DD.&-o <br />+ 147 <br />❑ Risers leaking <br />Address: <br />p <br />&. . :ccJ <br />kw <br />Other Rep i s: yG <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />City/State/Zip: <br />❑ Non-domestic waste ❑ Ponding/Surfacing <br />❑ Effluent Filter/screen ❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Total Cost of Service: <br />k <br />Payment Method: <br />Check <br />❑ Cash ❑ Credit <br />400, <br />do <br />-4;� L] ( E> <br />b CV <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />Tank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />cracked, <br />unsecured, or appears to be <br />structural) unsound <br />D— eptic/holding Tank #1 <br />El Yes <br />C Io� <br />❑Yes <br />E7-Pdo <br />❑Yes Cn'l�o <br />Gallons: t S'0,� <br />0-Septic/holding Tank #2 <br />❑ Yes <br />0''9-0— <br />❑Yes <br />❑Yes <br />Gallons: <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Pump Tank <br />❑Yes <br />Q No <br />❑Yes <br />[ <br />❑Yes <br />Gallons: l pep <br />1 <br />-low Accessed:[Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) ❑ Yes 2<0 ❑ Nc 4 <br />Did you Identify any operational issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />- -f i ,..r«;.,., ti.rf — h—L— -c orr 7 if cn. exnlaln In comments below. <br />Tank #1 ❑ Yes Ef No <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes No System <br />❑ Structural Integrity <br />❑ Structural integrity <br />❑ Structural integrity ETMound <br />Q Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking ❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles ❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues ❑ Trenches <br />❑ Non-domestic waste ❑ Ponding/Surfacing <br />❑ Effluent Filter/screen ❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: ErOastewater Treatment Plant W"' ' <br />)isposal Site: Lime: <br />Gallons ? —o -C> <br />Plowed: ❑ Yes <br />❑ No <br />Fime: <br />Temperature: <br />pH: <br />> 12 ❑ <br />rime: <br />Temperature: <br />pH: <br />>12 0 <br />