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Jim Eicher <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE '9- (C- L-f' <br />Maintainer 0 Jim <br />(Vick <br />= Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: <br />Address: 1 1 ©S <br />l J v l <br />Long Pull Fee: <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Se <br />A" <br />Payment Method: ❑ Che-1, ❑ Cash <br />Credit <br />�a <br />¢ <br />-71. Q o <br />Tank leaks above t <br />Maintenance hole <br />ver is damaged, <br />elow the <br />Tank (check i <br />ausignen ting depth <br />designed operating dep <br />cracked, unsecu <br />d, or appears to be <br />stru rall <br />unsound <br />Fer'S'eptic/holding Tank #1 <br />Gallons: Z5� <br />❑Yes El No <br />El Yes El No <br />El Yes <br />ElNo <br />❑ Septic/holding Tank #2 <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />EI-Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: -1T4 <br />G� <br />'Pll�ump Tank <br />Gallons: to-&o <br />❑ Yes ❑ No <br />El Yes ❑ No <br />❑Yes <br />❑ No <br />How Accessed: ❑ Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />❑ Yes El No <br />❑ Yes El No <br />i- <br />-4 �c� <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 <br />Tank #2 ❑ Yes ❑ No <br />Pump Tank ❑ Yes ❑ No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Mound <br />❑ 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: ❑ Land Application: ErW--astewater Treatment Plant l.-4--o—"�_ <br />Disposal Site: <br />Lime: <br />Gallons _ -3 <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />- -it onz,���-� Vim, �,✓`r �..�� ,.,�+'"`�. ,�..�ti ,�./ 1"._041- <br />