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Jim Eicher Maintenance Inspection Form <br /> MP Lic. # 654 <br /> ,.�+A,�T`, Maintainer Jim <br /> `�► I 1 Duane <br /> DVANkS I J Nick <br /> Septic Service, LLC <br /> 1205 LaBeaux Ave NE • Phone: 763-497-2764 <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE (0—t q"23 <br /> INVOICE <br /> Pumping Fee: ._, Name: Aacvyvl c g r.ct <br /> Long Pull Fee: z„..? fAddress: 1-0,,,00_,,,,,„„ti <br /> Other Repairs: <br /> " 70 Ct Ovey, ..1..0.t-5 City/State/Zip: <br /> 4 /0a zo `r C>�� <br /> Total Cost of Servic • Payment Method: ❑ Check ❑Cash ❑ Credit <br /> 4 67 <br /> Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, <br /> Tank(check if present) cracked,unsecured,or appears to be <br /> designed operating depth designed operating depth <br /> structurally unsound <br /> Septic/holding Tank#1 <br /> Gallons: �' 0 Yes Flo` ❑ Yes C1a 0 Yes CT Na <br /> fptic/holdin Tank#2 <br /> Gallons: /;2 ❑ Yes ❑ Yes C "No El Yes C�No <br /> ❑ Pretreatment Tank <br /> Gallons: ❑ Yes ❑ No ❑ Yes 0 No CIYes 0 No <br /> imp Tank �� <br /> Galians:II � ❑ Yes Q Na ❑ Yes LIT‹.---- <br /> ❑ Yes Fr No <br /> l <br /> How Accessed:®Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For P m in : <br /> 0 Other(see attached) 0 Yes Crgo ❑les 0 No 4. <br /> Did you Identify a y operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e,, <br /> eked tanks,missing baffles,broken co s,etc.?If so, explain In comments Gel .w. <br /> Tank#1 ❑ Yes o Tank#2 ❑ Yes o Pump Tank ❑ Yesa System <br /> ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity 'foound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfleld <br /> ❑ Baffles 0 Baffles ❑ Baffles 0 Pressure bed <br /> ❑ Non-domestic waste 0 Non-domestic waste 0 Electrical Issues ❑ Trenches <br /> El Non-domestic waste 0 Ponding/Surfacing <br /> ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? 0 Yes ❑ No <br /> Comments: <br /> Disposal: — ❑ Land Application: 0 Wastewater Treatment Plant <br /> Disposal Site: Lime: ----_ Gallons - Plowed: ❑ Yes_.a...❑ No <br /> �..C7�,�iiwl <br /> Time: I t._, e t.3 Temperature:p pH; i ,,° a j 2--❑ <br /> Time: t ; :z., Temperature: pH: , >12F Ci <br /> • .► c . THANKS! ,• ,• <br /> '.... cam , . - $ .. cam' •igjo.h........S, <br />