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Jim Eicher Maintenance Inspection Form <br /> MPCA Lic. #654 <br /> •�►Li <br /> �a i Maintainer I I Jim <br /> q., �-% <br /> WAV�.."� I I Duane <br /> ES t;— 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 Cf 1-2 <br /> INVOICE <br /> Pumping Fee: N e. <br /> Long Pull Fee: Address: <br /> 3CoCac1' <br /> Oth .. Repairs: ' City/State/Zip: <br /> 913, <br /> 7-) <br /> Total Cost of Se ce: ` Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> 1 43 t/0-c-,0 <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: a, ❑ Yes Er-Flo ❑ Yes 0 No 0 Yes rt No <br /> C r eptic/holding Tank#2 � � <br /> Gallons: 1 ❑ Yes VU ❑ Yes l�,L.l 6' 0 Yes o <br /> ❑ Pretreatment Tank <br /> Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> , ❑ Pump Tank <br /> Gallons: ❑ Yes 0 No ❑ Yes ❑ No ❑ Yes ❑ No <br /> How Accessed:Ortagtenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> El Other.(see attached) ❑Yes Ergo 2'Yes ❑ No r1-t c:1t.-' <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 0 Yes 0 No System <br /> 0 Structural integrity ❑ Structural integrity ❑ Structural integrity 0 Mound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> 0 Non-domestic waste ❑ Non-domestic waste 0 Electrical issues 0 Trenches <br /> ❑ Non-domestic waste 0 jading/Surfacing <br /> 0 Effluent Filter/screen ZII Othe : <br /> Cleaned? 0 Yes 0 No (-4•P I ik <br /> Comments: <br /> &rQ- - , `J cL1i by Ire vo. 1.7 0 G tk <br /> Disposal: 2"fand Application: ❑Wastewater Treatment Plant <br /> Disposal Site: Lime: / Gallons r 5— Plowed: ❑ Yes 110 <br /> Time: t 6 f Temperature: j 2._`"? pH: 12,t( >12 , ' <br /> Time: i/ 1.._, Temperature: t 5,3 pH: 11, -`" >12 E- <br /> .• J _ Q THANKS! r .. 2.A., <br /> � ,, <br /> .W."..4 cam .-.S <br />