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Jim Eicher Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer [:3 Jim <br />ED Duane <br />p L� Nick <br />Septic Service, LLC - Phone: 763-497-2764 <br />1245 LaBeaux Ave NE <br />St. Michael, MN 55376 - Email: duaneseptic@centurylink.net <br />DATE _INVOICE <br />Pumping Fee: Name: <br />Long Pull Fee: <br />Address: <br />❑ Et w§W dre[rwbtd <br />Q Baffin 0 BdIIBO <br />Other Repairs: <br />- <br />CitylState2ip: <br />Q Ncin-dDmesft wade <br />I <br />C Ef%M F0Wi5r3eDn <br />Total Cost of Service: <br />Clbened7 C Yee ❑trio <br />Payment Method: <br />❑ Check ❑ Cash O Credit <br />Tank leaks 113010W the <br />Tank leaks above the <br />Rla#ntenance hole cover is damaged, <br />Tank (check if present) <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to de <br />StrUCturaily unsound <br />#dJhong Tank 1 <br />Gs <br />GaJ[onllons: <br />U Yes No <br />L Yes <br />L) 'No <br />❑ Yes Q No <br />13 Septicftiding Tank #2 <br />t <br />Gallons: <br />� � Yes Q No <br />� Yes <br />C3"No <br />Q Yes 7 No <br />} <br />Q Pretreatment Tank <br />Gallons: <br />Yes Q Nv <br />L7 Yes <br />❑ No <br />Cl Yes No ' <br />Pump Tank <br />Gallons: I <br />G <br />C Yes ff No <br />D Yes <br />0- No <br />Q Yes Q No <br />ScumlSl ulige Measured I Maintenance <br />C Other (see attached) ! Yes a No 1 © Yes <br />Replaced. I Reason For Pumping. <br />❑ No <br />W yW kfeodfY wyY ap&atbnal 1s5,._, .s. u;rwlr _.. 44bris wade asses. V the SEwage tankS m Mk system, [.e., <br />aacxed tesla, mrss ' ov-5 e!r_ !r s, �pratn en cam,ncn[s beAon. <br />gs LINO Tank t2 --- .4 ' - ' Yes ❑ No System <br />❑ stn/Cuw 4Neprlljf Q r. t. . - _ - - <br />0 A"WS IDA" ci Roas iO"Ov <br />❑ Et w§W dre[rwbtd <br />Q Baffin 0 BdIIBO <br />❑ Pi w xe Wd <br />L7 Non-dornesoc waste :1 NOrrdome <br />❑ Trendies <br />...;u[al raegntY171-Mound <br />Q Elms ieekirX] <br />❑ Et w§W dre[rwbtd <br />❑ EWA%@ <br />❑ Pi w xe Wd <br />Q Ebcail et I6SUett <br />❑ Trendies <br />Q Ncin-dDmesft wade <br />❑ PQf4[[7gj$ur4" <br />C Ef%M F0Wi5r3eDn <br />❑ 0lhW <br />Clbened7 C Yee ❑trio <br />Comments. <br />Dispose: C Land AppGCabon C llmsieweler Tnmwn v Pl.rn <br />Disposal Site: <br />Time: <br />Time: <br />Low <br />Gallons <br />t Temperature <br />Ternpeiraiure: <br />Plowed h Yes Na-- <br />PH <br />