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Jim Eicher Maintenance Inspection Form <br /> -4)• <br /> MPCA Lic. # 654 <br /> ,,,,�,�tffj Maintainer I I Jim <br /> •� <br /> '."� U Duane <br /> MA A n Nick <br /> Septic Service, LLC <br /> 1205 LaBeaux Ave NE • Phone: 763-497-2764 <br /> St. Michael, MN 55376 •Email: duaneseptic@centurylink.net <br /> DATE 6'I 2-`- <br /> INVOICE <br /> Pumping Fee: . . Name: <br /> - "C," }ter , n; <br /> Long Pull Fee: Address: <br /> Other Rep(4e $ p i{ Q�n� City/State/Zip: <br /> 4 74>e,-4,0 <br /> Total Cost of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> 4'37(2..e.,-\.> <br /> Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, <br /> Tank(check if present) cracked,unsecured,or appears to be <br /> designed operating depth designed operating depth <br /> structurally unsound <br /> ®-Septic/holding Tank#1 <br /> Gallons: ,$"-b ❑ Yes p--t�(o ❑ Yes No ❑ Yes -t�To <br /> ❑ Septic/holding Tank#2 <br /> Gallons: ElYes ❑ No EllYes ❑ No ❑ Yes ❑ No <br /> ❑ Pretreatment Tank - <br /> Gallons: ❑ Yes ❑ No ClYes CINo ❑ Yes ❑ No <br /> 0 Pump Tank <br /> Gallons: CIYes ElNo ❑ Yes ❑ No ❑ Yes ElNo <br /> How Accessed:maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> ❑Other(see attached) El Yes ❑ No ❑ Yes El No e_�� . <br /> Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system,1.e., <br /> .-cracked tanks,missing baffles,broken covers,etc.?If so, explain in comments below. <br /> Tank#1 0 Yes ff No Tank#2 0 Yes ❑ No Pump Tank 0 Yes 0 No System <br /> ❑ Structural integrity El Structural integrity 0 Structural integrity ❑ Mound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles 0 Baffles ❑ Baffles ❑ Pressure bed <br /> 0 Non-domestic waste 0 Non-domestic waste ❑ Electrical issues 0 Trenches <br /> ❑ Non-domestic waste 0 Ponding/Surfacing <br /> 0 Effluent Filter/screen 0 Other: <br /> �yy Cleaned? 0 Yes 0 No <br /> Comments: -i. �a eu•ikk e �'t .,,a+ti 4•,ti..k ' +-' ee,o...,-e C A (2,„ ti,,c,.. <br /> e"-w-e 5 <br /> Disposal: i3'"Land Application: ❑Wastewater Treatment Plant <br /> V. <br /> Disposal Site: i Lime: Gallons 5-7,-.0 Plowed: El Yes iNo <br /> Time: (2.33 Temperature: lc,.0 pH: I 2,_ 3 >12 C <br /> Time: Ir,9 Temperature: .10 pH: t�-3 >12 EJV <br /> • 4" <br /> ",,..„.t-,-...N./. NWrI <br /> @Me THANKS! -.400,... ,.,.4, ., �� r 4Ei....i.) 4.11 <br /> ,, <br /> x/ 14 A4ep.p-.-* <br /> ..,~,~ S , a ; ,. ,""'►�..,,,, re1„11171.1c1...* <br /> . <br />