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Jim Eicher Maintenance Inspection Form <br /> -4MMPCALic. # 654 <br /> !j Maintainer ! 1 Jim <br /> �.ArI Z . I 1 Duane <br /> WANES�� , 't ick <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE �(-i(- a 3 INVOICE <br /> Pumping Fee: 7fff ✓ Name: I, f-1-1-cisq ( _, <br /> Long Pull Fee: Address: Li --e_6 s c. Ix , pp e-,, .. L ,. -�.. <br /> Other Repairs: I c City/State/Zips flo4,B ,. <br /> _ . 0,rca.0 <br /> Total Cost of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> $L/33. LO <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 /> C�t`Septic/holding Tank#1 ❑ Yes Ills No ❑ Yes C7 No ❑ Yes EIT <br /> Gallons:lcQ2 <br /> El"Septiclholding Tank#2 ❑ Yes Ci•lao ❑ Yes �YNo ❑ Yes ❑No <br /> Gallons:Lam-, . <br /> El Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Gallons: <br /> ❑ Pump Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Gallons: <br /> How Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> ❑Other(see attached) ❑Yes 't7 No r Yes ❑ No 'rl'`e , <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 givers,etc.?If so, explain in comment elow. <br /> Tank#1 ❑ Yes 1:3-101 Tank#2 ❑ Yes ❑l No Pump Tank CI Yes rgeNo SystemSystem <br /> ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity "Niound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> ❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues 0 Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes ❑ No <br /> Comments: <br /> Disposal: ❑ Land Application: ‘Vastewater Treatment Plant <br /> Disposal Site: Lime: Gallons } Plowed: 0 Yes ❑ No <br /> Time: Temperature: pH: >12 ❑ <br /> Time: Temperature: pH: >12 ❑ <br /> ,� _ Jr 414 <br /> . C� THANKS! �. �,,�''�'�;.�..� Cyr !`./,/�- '�..t i�+f . ,`♦„r�"f, _ �. .�_ ,�� --�"`"��►rifir.r.d.�� . <br /> 4/'�''"� —..d-4"�r --�, S <br />