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Jim Eicher <br />��� L(%� <br />� � 1�-� <br />l � ���-� . <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE � `��1 � :� J <br />Mainteru���� i���o�@��u©fry �©�� <br />MPCA Lic. #L4286 <br />Maintainer � Jim <br />O Nick <br />0 Sam <br />Phone: 763-497-2764 <br />m Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: r <br />�-- <br />Name: � <br />_ <br />Long Pull Fee: � ��--- <br />Address: L� 1 �v <br />�, �� <br />iC �c,c<x <br />�� <br />i <br />`, ` <br />Other Repairs: <br />City/State/Zip: <br />r ' l,, <br />I <br />1 '� <br />�'`� <br />r; <br />Total Cost of Service: ,r' <br />/ <br />Payment Method: <br />❑Check ❑Cash <br />❑Credit <br />�. <br />Maintenance hole <br />cover is damaged, <br />Tank (check if present) <br />Tank leaks <br />below <br />the <br />Tank leaks above the <br />cracked, unsecured, <br />or appears to be <br />designed <br />operating <br />depth <br />designed operating depth <br />structural) <br />unsound <br />Septic/holding Tank #1 <br />� <br />�� <br />�❑ <br />Gallons:;'t.'�.-,J <br />❑Yes <br />❑� <br />No <br />❑Yes <br />No <br />❑Yes <br />L7 No <br />� Septic/holding Tank #2 <br />- <br />� <br />Gallons: ��;>�' � <br />❑Yes <br />0 <br />No <br />❑Yes ' <br />� No <br />❑Yes <br />� No <br />❑ Pretreatment,Tank <br />❑Yes <br />❑ <br />No <br />❑Yes <br />❑ No <br />❑Yes <br />❑ No <br />Gallons: <br />Pump Tank <br />_ <br />Gallons: u J <br />❑Yes <br />.❑ <br />No <br />❑Yes <br />0" No <br />❑Yes <br />: � No <br />; . <br />How Accessed:❑Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑Yes �� �No <br />"� <br />�es ❑ No <br />!�_ <br />�' <br />Did you identify any operational issues or unsafe conditions <br />while <br />assessing the <br />sewage tanks in this system, i.e., <br />cracked tanks, missing baffles, broken covers, <br />etc.) <br />If so, explain <br />in comments below. <br />Tank #1 <br />Yes ❑ No <br />Tank #2 <br />❑Yes ❑ No <br />Pump Tank ❑Yes ❑ No <br />System <br />.❑ <br />❑ <br />Structural integrity <br />❑Structural <br />integrity <br />❑Structural integrity <br />� <br />Mound <br />❑ <br />Risers leaking <br />❑Risers <br />leaking <br />❑Risers leaking <br />❑Elevated <br />drainfield <br />❑ <br />Baffles <br />❑Baffles <br />❑Baffles <br />❑Pressure <br />bed <br />❑ <br />Non -domestic waste <br />❑Non <br />-domestic waste <br />❑Electrical issues <br />❑Trenches <br />� �'�� <br />} ��� i � � I�. <br />❑ Non -domestic waste <br />❑Effluent Filter/screen <br />❑ <br />❑Other: <br />Ponding/Surfacing <br />Cleaned? ❑Yes ❑ No <br />Comments: <br />Disposal: ❑Land Application: ❑Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />��_ <br />