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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nAYU Cn -l 1--7 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fe-- <br />Name: <br />Long Pull FE <br />Address:. <br />t <br />`� <br />Other Repai <br />City/State/Zip: <br />Total Cost of <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />0L4 <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />ank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />2-9'eptic/holding Tank #1 <br />Li Yes Cho <br />❑Yes <br />No <br />El Yes n-No <br />Gallons: � <br />Septic/holding Tank #2 <br />❑Yes Q No <br />❑ Yes <br />/ <br />C No <br />El Yes �o <br />Gallons: too <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Pump Tank <br />❑ Yes No <br />❑ Yes <br />0" No <br />❑ Yes �No <br />Gallons: Cep <br />-low Accessed: Maintenance Hole <br />Scum/SSl ge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />Q Yes ❑ No <br />�TYes ❑ No <br />f�-�°L" <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />nrLa1 f—Lc mlednn haff/oa hrnkon snverc. etr.7 If so. eXolain in comments below. <br />Tank #1 ❑ Yes ZNo <br />Tank #2 ❑ Yes 25 No <br />Pump Tank ❑ Yes ONo <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ETMound <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: Er[and Application: ❑ Wastewater Treatment Plant <br />disposal Site: - ( <br />Lime: <br />Gallons Z WO <br />Plowed: <br />❑ Yes o <br />rime: 1 (3 o <br />Temperature: t b.-7 <br />pH: <br />1 2. $ > 12 Cd' <br />rime: i Za Z <br />Temperature: 1'?. [ <br />pH: <br />t 2 3 > 12 rT <br />��.-.� cam' ,,�.,`���,� �� • �, ��� '�-�_ ���,�;�'1.1.� <br />