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Jim Eicher <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />DV�E� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 9- (i- 2-5' <br />Maintainer 0 Jim <br />'Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink,net <br />INVOICE <br />Pumping Fe <br />Name: <br />0 <br />Vk!" V-J <br />Address: <br />Long Pull R <br />Other Repa <br />City/State/Zip: <br />C)VDf\'o <br />Total Cost c <br />e"w w <br />Payment Method: Check ❑ Cash <br />❑ Credit <br />_ <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />leaks below the <br />Tank ( <br />operating depth <br />designed operating depth <br />cracked, unsecured, <br />or appears to be <br />— <br />structurally <br />unsound <br />❑ Septic/holding Tank #1 <br />El Yes 0 No <br />El Yes Cam_. <br />El Yes <br />No <br />Gallons: ��.� <br />❑ Septic/holding Tank #2 <br />," <br />El Yes [3' No <br />El Yes No <br />El Yes <br />No <br />Gallons: <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pump Tank <br />El Yes No <br />❑ Yes �" No <br />El Yes <br />Gallons: (,�?-.� <br />How Accessed: El Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />2rles ❑ No <br />l� ❑ No <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 commenttss.below. <br />Tank #1 ❑ Yes n No <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ETMound <br />Cl Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non -domestic waste <br />❑ Non -domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? [--]Yes ❑ No <br />Comments: <br />Disposal: 13<and Application: ❑ Wastewater Treatment Plant <br />Disposal Site: ✓ t <br />Lime: <br />Gallons D0-0- <br />Plowed: <br />❑ Yes <br />zrNo <br />Time:. <br />Temperature: t <br />pH: <br />> 12 2-- <br />Time: <br />to Y 7 <br />Temperature: <br />pH: <br />t z• 2- <br />> 12 <br />�► .,.fib • �' Nei • ,� <br />