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Jim Eicher Maintenance Inspection Form <br /> MPCA Lic. # 654 <br /> Jtar Maintainer I I Jim <br /> '7 I I Duane <br /> '-** <br /> DuRNEW <br /> Nick <br /> A <br /> Septic Service, LLC <br /> 1205 LaBeaux Ave NE • Phone: 763-497-2764 <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE -6-Z 3 INVOICE <br /> Pumping Fee: Name: <br /> 0_ ' i►� ,( , i- 12' f <br /> Long Pull Fee: Address: '° <br /> Other Repairs: City/State/Zip: <br /> Total Cost of Se ce: j Payment Method: ❑ Check ❑ Cash ❑ Credit <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 structurally unsound <br /> c/holding Tank#1 ❑ Yes <br /> Gallons: ❑ Yes CI Yes ❑ No <br /> -7 - <br /> Cl ptic/holding Tank#2 <br /> Gallons:,--7 ❑ Yes r�-'�10 ❑ Yes C'No O Yes ❑ No <br /> ❑ Pretreatment Tank <br /> Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ElNo <br /> ❑ Pump Tank <br /> Gallons: ❑ Yes ❑ No ❑ Yes ClNo 0 Yes ❑ No <br /> How Accessed:❑Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> tt <br /> tv, vvv vt0c Other(see attached) O Yes E 11 ❑ Yes ❑ No i 1 <br /> Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system,i.e,, <br /> ked tanks,missing baffles,broken covers,etc.?If so, explain In comments below. <br /> Tank#1 ❑ Yes roo c Tank#2 ❑ Yes Pump Tank 0 Yes D No ^ System <br /> ❑ Structural integrity D Structural integrity ❑Structural integrity ❑ Mound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles 0 Baffles ❑ Press re bed <br /> ❑ Non-domestic waste ❑ Non-domestic waste 0 Electrical issues nches <br /> 0 Non-domestic waste 0 Ponding/Surfacing <br /> ❑ Effluent Filter/screen El Other: <br /> Cleaned? El Yes El No <br /> Comments: <br /> Disposal: © Land Application: ❑Wastewater Treatment Plant <br /> Disposal Site: f Lime: '".---- Gallons ( Plowed: 0 Yes EfICIT <br /> Time: /O ti f Temperature: 12,,7 _ pH: 1 2,,, 1 >12 ET— <br /> Time: (i 20 Temperature: ( 3,. '5 pH: 1 L. "- >12 7"--- <br /> . t 'r'. 0 ...� @MO THANKS!Q - '437, . ,, f 140 <br /> " 1_` <br />