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Jim Eicher Maintenance Inspection Form <br />CA Lic. # 654 <br />Maintainer [�� Jim <br />Duane <br />0 <br />D 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 �--1161- 0 � INVOICE <br />Pumping Fee: Name: <br />� �"i �,5 rt ✓'i � <br />Long Pull Fee: Address: ,La;..— 6� <br />�°�� q• CLQ � � <br />Other Repairs: City/State/Zip: <br />Total Cost of Service: <br />Payment Method <br />❑ Check I <br />Cash ❑ Credit <br />te�Septic/h IdWank #1 <br />Gallons: 7(,Z <br />❑Yes moo` <br />❑Yes f,�-fdo <br />❑Yes <br />[o <br />2'9`5`ptic/ oldin Tank #2 <br />Gallons: 10 V <br />❑ Yes o <br />❑ Yes <br />❑ Yes <br />o <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />12 Pomp Tank <br />Gallons: ��} <br />^ � <br />❑YesVo <br />❑Yes <br />11 Yes <br />o <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: Reason For Pumping: <br />p g: <br />❑ Other (see attached) <br />❑ Yes 944-0 <br />9,16s- ❑ No <br />Did you identify any operational Issues or unsafe conditions <br />while assessing the sewage tanks in this system, i.e., <br />cked tanks, missing baffles, brokencguera <br />Tank #1 Yes <br />etc.? If so, explain in comments low. <br />❑ No Tank #2 ❑ Yes ❑ No I <br />PumD Tank n YaG F -9 -an i c"etnw <br />Risers leakin ""' " ----"- '- ILUy"Lr �'mouna <br />9 ❑ Risers leaking ❑ Risers leaking ❑Elevated drainfieid <br />❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br />❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑ Trenches <br />❑ Non-domestic waste ❑ Ponding/Surfacing <br />Cl Effluent Filter/screen ❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br />Time: Temperature: pH: >12 ❑ <br />Time: Temperature: pH: >12 0 <br />