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Jim Eicher Maintenance Inspection Form <br /> 4MPCA Lic. #654 <br /> J,�ATIj Maintainer I I Jim <br /> t� <br /> 0 I 1 Duane <br /> DVANES 4.0 ick <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.-Z 3 INVOICE <br /> Pumping Fee: $ „, ...._ Name: <br /> / 5a Lie- :0 I Psi <br /> Long Pull Fee: Address: <br /> ZoGo r_-.1--x p,1 (c, <br /> Other Repairs. City/State/Zip: <br /> 1),ANvte it' <br /> Lovv5 LA, icc, <br /> Total Cost of Se 'ce: Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> 0/5:0-;) <br /> _._.____.) <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: t p 0 Yes 3'1�10 + ❑ Yes es ❑ Yes No <br /> ❑Septic/holding Tank#2 <br /> Gallons: ,a c� ❑ Yes C� No ❑ Yes [moo ❑ Yes ..1 'No <br /> ❑ Pretreatment Tank <br /> Gallons: ❑ Yes 0 No ❑ Yes CINo ❑ Yes ❑ No <br /> El Pump Tank ,,� <br /> Gallons: �,� ❑ Yes .""No ❑ Yes L" No ❑ Yes No <br /> LQ <br /> How Accessed:❑Maintenance Hole Scum/Sludge Measured Maintenance Holes SecurelyReplaced: <br /> �,.�' p Reason For Pumping: <br /> 0 Other(see attached) 0 Yes Le Pr-Ces ❑ No MOO O vt+ <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, brokenn Avers,etc,?If so, explain In comments b low. <br /> E <br /> Tank#1 0 Yes -t10 Tank#2 ElYes a'No Pump Tank ❑ Yes Lo System <br /> CI Structural integrity ❑ Structural integrity ❑ Structural integrity l3`Mound <br /> ❑ Risers leaking 0 Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles 0 Pressure bed <br /> 0 Non-domestic waste 0 Non-domestic waste ❑ Electrical issues ❑Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? 0 Yes 0 No <br /> Comments: }r) .,�4- -� <br /> p-c°W,WLe't c ) .i i- e . Pk-friP vt k: s b,,i•e...v-- <br /> 1 I C4 4- Jim etc, <br /> Disposal: Q'Cand Application: 0 Wastewater Treatment Plant <br /> Disposal Site: ` /4 Lime: "'.-''' Gallons <br /> "a (ca,c> Plowed: ❑ Yes ElIC(o <br /> Time: 1 ae ( Temperature: i S, 3 pH: I! >12 Li <br /> Time: (a 3 Temperature: t S', 'j pH: II. '3 >12 C <br /> ..� r THANKS! .• * 7 r <br />