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Jim Eicher Maintenance Inspection Form <br /> :4) MPCA Lic. # 654 <br /> 4 Maintainer [ l Jim <br /> it-dial I 1 Duane <br /> d <br /> MAIMS� [42Nick <br /> DVAN�� <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE Co" 21 2 3 INVOICE <br /> Pumping Fee: <br /> Name.AA � ,�,,� <br /> Long Pull Fee: {i e Address:2'74 4 3 <br /> Other Re airs: City/State/Zip: <br /> .1),,Ny,„p ...4.z._ Itgb,,..,,-.0 OTD,A0 <br /> Total Cost of Servic • Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> Maintenance hole cover is damaged, <br /> Tank leaks below the Tank leaks above the cracked,unsecured,or appears to be <br /> Tank(check if present) designed operating depth designed operating depth <br /> structurally unsound <br /> ptic/holding Tank#1 ❑ Yes l ` No ❑ Yes No ❑ Yes No <br /> Galllons:LOi#? /" <br /> C-f"Septiclholding Tank#2 ID Yes lo ❑ Yes ❑ Na ❑ Yes No <br /> Gallons: i F4' <br /> ❑ Pretreatment Tank ❑ Yes El No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Gallons: <br /> Q Pump Tank ❑ Yeso ❑ Yes Cal No ❑ Yes No <br /> Gallons: LE -o <br /> How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> El Other(see attached) ❑Yes No E"1'es ❑ No y �•'.1- <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,povers,etc.?If so, explain in comments iow. <br /> Tank#1 ❑ Yes [2'No Tank#2 ❑ Yes 2'No Pump Tank ❑ Yes re-No System .— <br /> El Structural integrity ❑ Structural integrity ❑ Structural integrity l 'Mound <br /> ❑ Risers leaking Cl Risers leaking El Risers leaking ❑ Elevated drainfield <br /> El Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> El Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes ❑ No <br /> Comments: <br /> Disposa <br /> l: ❑ Land Application: C3 Wastewater Treatment Plant <br /> Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br /> Time: Temperature: pH: >12 ❑ <br /> Time: Temperature: pH: >12 ❑ <br /> Jo 015040, . lir• t..� C THANKS! ,. . V .._.� <br /> _ a <br /> .*LARILW ;,. "%o* -._...111111/1 ""'. .-1M0.4‘VP OP* <br />