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Jim Eicher Maintenance Inspection Form <br /> 4 MPCA Lic. #654 <br /> J� Maintainer z Jim <br /> s. 01 `7 I I Duane <br /> MANES I <br /> M � 1Nick <br /> � <br /> Septic Service, LLC <br /> 1205 LaBeaux Ave NE • Phone: 763-497-2764 <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE 6-6-2_3 <br /> INVOICE <br /> Pumping Fee: Name: <br /> 4-`tf 13 r ,• ,, ,..)C,i <br /> Long Pull Fee: Address: 7 ---- <br /> 7 <br /> it." itt"- rci c4 cOn <br /> Other Repairs: City/State/Zip: <br /> Total Cost of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit <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 /> eptic/holding Tank#1 <br /> Gallons: CIYes ❑ No ❑ Yes ❑ No ElYes ❑ No <br /> .P`Septic/holding Tank#2 <br /> Gallons: CIYes 0 No ❑ Yes ❑ No ❑ Yes ❑ No <br /> ❑ Pretreatment Tank <br /> Gallons: 0 Yes ❑ No ❑ Yes 0 No 0 Yes ❑ No <br /> ❑ Pump Tank <br /> Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> How Accessed:❑Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> El Other(see attached) 0 Yes ❑ No Cl Yes ❑ No Are IAJ 57c7r P... <br /> Did you Identify any operational issues or unsafe conditions while assessing the sewage tanks in this system,i.e., <br /> cracked tanks,missing baffles, broken covers,etc.?If so, explain in comments below. <br /> Tank#1 ❑ Yes ❑ No Tank#2 ❑ Yes ❑ No Pump Tank El Yes 0 No System <br /> ❑ Structural integrity ❑ Structural integrity 0 Structural integrity ❑ Mound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> ❑ Non-domestic waste El Non-domestic waste ❑ Electrical issues ❑Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> El Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes 0 No <br /> Comments: <br /> Disposal: —-D"Land Application: ❑Wastewater Treatment Plant <br /> Disposal Site: LI Lime: t/ Gallons t, 0,, Plowed: ❑ Yes ❑ No <br /> Time: t Temperature: pH: l , £-.: >12..,.0 <br /> Time: ,, ,}, Temperature: pH: -; >12 ID <br /> 'w. C.P'. V ,, .. THANKS! ,., ? , ...* <br />