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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael,MN 55376 ^ <br />M w9rF- /_ I --1 '7 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: ti <br />4'\ <br />CA, <br />Address: ZS, <br />-1-�kc.�> 5 lam' �l <br />Long Pull Fee: <br />Other Repairs: <br />City/State/Zip: <br />� ivy <br />Total Cost of Ser <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />o.. <br />Maintenance hole cover is damaged, <br />Tank (check i <br />ik leaks below the <br />Tank leaks above the <br />cracked, unsecured, or appears to be <br />ned operating depth <br />designed operating depth <br />structural) <br />unsound <br />Septic/holding Tank #1 <br />❑ Yes Er-K-0 <br />❑ Yes <br />77No <br />❑ Yes <br />ET- 'No <br />Gallons: tooc) <br />Septic/holding Tank #2 <br />El Yes No <br />El Yes <br />L� No <br />❑Yes <br />Gallons: v-� <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />ETIP"ump Tank <br />El No <br />El <br />Z No <br />ElYes <br />��10 <br />Gallons: (,�� <br />-iow Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) El Yes � Nuro 0 Yes ❑ No V�L,. �'r <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />t,. I ra ­ in i-nm tc hainw_ <br />Tank #1 ❑ Yes EYNo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes Z NomPonding/Surfacing <br />❑ Structural integrity <br />❑ Risers leaking <br />❑ Structural integrity <br />❑ Risers leaking <br />❑ Structural integrity <br />❑ Risers leaking <br />infield <br />❑ Baffles <br />❑ Non -domestic waste <br />❑ Baffles <br />❑ Non -domestic waste <br />❑ Baffles <br />❑ Electrical issues <br />❑ Non -domestic waste <br />facing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments:T��w c��� kA- ?L'V' leIC5 GQ©vet 40 <br />4., K 4 <br />Disposal: SLand Application: ❑ Wastewater Treatment Plant - <br />Disposal Site: �`Z- Lime: Gallons a Plowed: El Yes C�' Time: OCI Temperature: t �• pH: (L_ Z > 12 <br />Time: `3' $ Temperature: Z0-0 pH: iZ-Z. >12 <br />•�:.�, �.sr� �-�� ....�---� �•-'��, ✓" sue. <br />