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Jim Eicher <br />i <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN % 55376 <br />nA - � . 1�i 7_ v" <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />Duane <br />[� Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />✓P I — • - <br />Pumping Fee:Name: <br />sz) <br />J v <br />Tank #2 ❑ Yes [5 --No <br />Pump Tank ❑ Yes o <br />C j_ t <br />I'-'7��`� <br />S / U - <br />Long Pull Fee: <br />❑ Structural Integrity <br />RrUound <br />Address: q r <br />❑ Risers leaking <br />Other Repairs, q <br />4� �� <br />❑ Baffles <br />City/State/Zip: <br />❑ Baffles <br />!! <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />0 Hyl <br />❑ Trenches <br />Total Cost of Servic <br />❑ Non-domestic waste <br />Payment Method: Check ❑ Cash ❑ Credit <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Maintenande hole cover Is damaged, <br />Tank (check if present) <br />Tank 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 />Septic/din Tank #1 <br />ElYes <br />ff No <br />[IYes _21, -Vo <br />C1Yes .6 <br />Gallons: ;1, <br />eptic/holding Tank #2 <br />Gallons:la <br />❑ Yes <br />�' <br />t No <br />LiYes er_fTo <br />❑ Yes - T� No <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />ump Tank <br />❑ Yes <br />No <br />❑ Yes No <br />_� <br />❑ Yes ❑ No <br />Gallons:,'�i <br />-how Accessed;RVaintenance Hole Scum/Sludge Measured Maintenance H les Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ Yes W90 es ❑ No = �-✓ <br />Did you Identify an}_ operational issues or unsafe conditions while assessing the sewage tanks in this system, I.e., <br />......a,_ --i" ... n i. fflne hmLan rnv PYr-.7 rf M. AYnlaln In comments bWew. <br />Tank #1 ❑ Yes nNo <br />Tank #2 ❑ Yes [5 --No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural Integrity <br />RrUound <br />O Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />O 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: ❑"Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: <br />Gallons <br />211CWO <br />Plowed: ❑ Yes <br />❑._No <br />Time: t , <br />Temperature: <br />k t '3, <br />pH: i 3 <br />>12 -_0 <br />Time: <br />Temperature: <br />1 <br />pH: <br />> 12-0 <br />