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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />.- CT rt 1 .7 .3 <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer D Jim <br />[� Duane <br />'Nick <br />• Phone: 763-497-2764 `' <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />vr� a_ 0 v r <br />Pumping Fee: •Name, <br />r <br />Tank #2 ❑ Yes o <br />�- <br />System <br />F% _63_o <br />❑ Structural integrity <br />❑ Risers leaking <br />I? . �L <br />5 <br />❑ Baffles <br />Long Pull Fee: <br />��� <br />❑ Baffles <br />Address: <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />�� c9-7 <br />❑ Trenches <br />❑ Ponding/Surfacing <br />Ua <br />❑ Effluent Fllter/screen <br />Other Repairs: <br />City/State/Zip: <br />Cleaned? ❑ Yes ❑ No <br />Comments: ��n 3 5• r—A <br />�,,�. � .-,,vl e �v,���-J,�.��I�-s tiw �`Ir�.s i�wl��. t,���es <br />47"+ we otZs=' C:t j/Ok C- ¢ ttl1 <br />3-2 <br />�I �yJL J <br />Total Cost of Service: <br />- <br />Payment Method: ❑ Check <br />❑ Cash <br />❑ Credit <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, unsecured, or appears to be <br />structural) <br />unsound <br />Septic/holding Tank #1 <br />❑ Yes <br />a Jho ^ <br />❑ Yes U -No <br />❑ Yes <br />❑' 10 l <br />Gallons: 57l9p <br />eptic/holding Tank #2 <br />❑ Yes <br />E No <br />❑ Yes 0'No <br />❑ Yes <br />No <br />Gallons: <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />ET'Pump Tank <br />11 Yes <br />C� No <br />❑ Yes C_ No <br />❑ Yes <br />,/ <br />n No <br />Gallons: f <br />How Accessed:9,9,ntenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ Yes B<o es ❑ No L'v Reason <br />Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />..tee..,. a.,an.... k..&- r , ah- 7 iF en pvnlaln In rnmments below. <br />Tank #1 ❑ Yes ETNo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />O Risers leaking <br />❑ Structural integrity <br />❑ Risers leaking <br />❑ Structural integrity <br />❑ Risers leaking <br />Lei Mound <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical Issues <br />❑ Non-domestic waste <br />❑ Trenches <br />❑ Ponding/Surfacing <br />❑ Effluent Fllter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: ��n 3 5• r—A <br />�,,�. � .-,,vl e �v,���-J,�.��I�-s tiw �`Ir�.s i�wl��. t,���es <br />47"+ we otZs=' C:t j/Ok C- ¢ ttl1 <br />3-2 <br />F "_" <br />Disposal: El'Cand Application: ❑ Wastewater Treatment I lant Itr <br />Disposal Site: <br />Lime: <br />Gallons 2 4:70 <br />Plowed: <br />❑ Yes o <br />Time: <br />�(`� <br />Temperature: (v <br />pH: <br />2�5 > 12 <br />Time: <br />n ( <br />Temperature: Cao, <br />pH; _t,2- <br />> 12 <br />NBuie <br />