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Jim Eicher Maintenance Inspection Form <br /> :4MPCA Lic. #654 <br /> •r�� i Maintainer I I Jim <br /> ovhi..) <br /> ``�� "� I I Duane <br /> 1 Nick <br /> MAWS ! <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE Co—IC•• 2- 3 INVOICE <br /> Pumping Fee: Name; <br /> t..lk AS 7 Q CLL.. I <br /> Long Pull Fee: Address: J <br /> ,s: LI 3 b 8-4-(A. b . R <br /> ther Repairs: -c -City/State/Zip: <br /> Total Cost of Sere' `'N 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 /> ❑'Septic/holding Tank#1 <br /> Gallons: t s-c5- ❑ Yes E7T"�No_ El Yes C�'I' !o ❑ Yes a <br /> E2'Septic/holding Tank#2 ,.- <br /> Gallons: / -,r, ❑ Yes ! No ❑ Yes 0 Yes <br /> ❑ Pretreatment Tank <br /> Gallons: ❑ Yes 0 No CIYes 0 No 0 Yes ❑ No <br /> 'Pump Tank <br /> Gallons: t 't <br /> ❑ Yes No ❑ Yes C No ❑ Yes �1 No <br /> How Accessed:ILb1"aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> ❑Other(see attached) ❑Yes iIo ®'Yes ❑ No vv-0H,,, <br /> Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system,i.e., <br /> racked tanks,missing baffles,bro__ken,�c-overs,etc.?If so, explain In commen elow. <br /> Tank#1 ID Yes f No Tank#2 ❑ Yes ❑.�vo Pump Tank ❑ Yes Er System'' <br /> ❑ Structural integrity 0 Structural integrity 0 Structural integrity ��f"Mound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles El Baffles ❑ Baffles 0 Pressure bed <br /> ❑ Non-domestic waste ❑ Non-domestic waste 0 Electrical issues 0 Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> El Effluent Filter/screen 0 Other: <br /> Cleaned? ❑Yes ❑ No <br /> Comments: <br /> Disposal: land Application: 0 Wastewater Treatment Plant <br /> Disposal Site: 'i Lime: Gallons 3/0-0 Plowed: ❑ Yes .;1-Mo <br /> Time: r'e9 i Temperature: ( 'L/ 1 pH: 12,L( >12 Er <br /> Time: q i(c, Temperature: 1 5-, ., pH: t Z,y >12 -0' <br /> 4j AV 4.«......1, @Mt THANKS! Aiii ,,,,(�.., 0 AV <br /> ..."-,.....1.44/ ' 4110, Cli.. . <br /> ,...�-.I�.� ,sue.. ,...�-'11C--N- ''r .sue. <br />