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Jim Eicher Maintenance Inspection Form <br /> .4 MPCA Lic.# 654 <br /> ,.�.rtai� 4,4% Maintainer I I Jim <br /> �, '� 1 1 Duane <br /> ► l ,. 11,,, ick <br /> DVANE� ;a- <br /> septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE (0—21 - 2 3 INVOICE <br /> Pumping Fee: F +-�/ \[^ Name: <br /> ,4,--,t2 *.e.-4,-- <br /> Long Pull Fee: Addres • 14 <br /> Other Repairs: City/State/Zip: <br /> O/"' s 1,4...cs <br /> Total Cost of Servic . Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> -- <br /> cracked,------ r k le below the Tank leaks above the Maintenance hole cover is damaged, <br /> Tank(check i cracked,unsecured,or appears to be <br /> designed operating depth designed operating depth structurally unsound <br /> C ptic/holding Tank#1 <br /> Gallons:L C ❑ Yes Lr 11 ❑ Yes ❑ El Yes C'TV�o <br /> ®'Septic/holding Tank#2 // ,.�-' ,,.� <br /> Gallons: ❑ Yes 0'No Cl Yes C-i�No ❑ Yes iii <br /> L000 <br /> ❑ Pretreatment Tank <br /> Gal��ions: ❑ Yes ❑ No ❑ Yes CI No ❑ Yes El No <br /> Pump Tank ❑ <br /> Gallons: *� Yes �''No 0 Yes ®'No ❑ Yes ,�]"'5o <br /> How Accessed:P1"Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced:laced: Reason For Pumping: <br /> ❑Other(see attached) 0 Yes CE'No s ❑ No ~ <br /> Did you identif any operational issues or unsafe conditions while assessing the sewage tanks In this system, Le., <br /> cracked tanks,missing baffles,brokenn givers,etc.. If so, explain in comments elow. <br /> Tank#1 ❑ Yes No Tank#2 ❑ Yes C .No Pump Tank ❑ Yes CP"No System <br /> ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity 0 Mound <br /> ❑ Risers leaking Cl Risers leaking ❑ Risers leaking 0 EipThiated drainfield <br /> ❑ Baffles ❑ Baffles 0 Baffles ressure bed <br /> O Non-domestic waste 0 Non-domestic waste 0 Electrical issues ❑Trenches <br /> El Non-domestic waste ❑ Ponding/Surfacing <br /> 0 Effluent Filter/screen 0 Other: <br /> Cleaned? 0 Yes ❑ No <br /> Comments: <br /> Disposal: Er"Land Application: ❑Wastewater Treatment Plant <br /> Disposal Site: 1 13 Lime: Gallons te."-- ' Plowed: 0 Yes Cho <br /> Time: 2 3 -7 Temperature: f-7..'- pH: t � -; >12 .'"-- <br /> Time: a i f Temperature: I a.. I pH: ( Z,3 >12 ge- <br /> -' .-.4 C '. r , ...0. <br /> s HA NKS! - .-.� Cam''. .4.Ad <br /> illb'``s <br /> Rom. • .-. r.. r/!-'‘*-� �''-^u ,..` ti...10 h R% �---' �!'"� r llr! <br /> ir0 <br />