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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
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<br /> x/ 14 A4ep.p-.-*
<br /> ..,~,~ S , a ; ,. ,""'►�..,,,, re1„11171.1c1...*
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