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1 <br /> Jim Eicher Maintenance Inspection Form <br /> iffh MPCA Lic. # 654 <br /> ' Maintainer Jim <br /> it!„, 1.J��� f I Duane <br /> Nick <br /> DVA IS <br /> Septic Service, LLC = Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE q' ( or - #2-. INVOICE <br /> Pumping Fee: 3,7_ Name: G e{,r <br /> Long Pull Fee: Address: /Les.° A 6 6, r,ril,‘ ek <br /> Other Repairs: r�-1 City/State/Zip: 2-10 5-356 OP <br /> Z ?o — eA0" 1--"L j'TN I/ ea J4rcef1 ftaCry <br /> Total Cost of Service: pur. `-, 4V r't o P thod: ❑ Check ❑ Cash redit <br /> t572- 4- - ?. 1U — inw. j [ iCo ,•)1.1., :,.0.r,,: , <br /> Maintenance hole cover is damaged, <br /> Tank leaks below the Tank leaks above the cracked,unsecured,or appears to be <br /> Tank(check if present) designed operating depth designed operating depth <br /> structurally unsound <br /> t eptic/holdi .Tank#1 <br /> D Yes Zl< ❑ Yes CS N/o IW Ke—s ❑ No <br /> Gallons: e 0. <br /> fie tic/holding Tank#2 ❑ Yes No Yes ❑ No <br /> p ❑ Yes to <br /> Gallons: [0-00 <br /> ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Gallons: <br /> m Tank / -n No ❑ Yes 'r No <br /> Pu p ❑ Yes �d"No ❑ Yes <br /> Gallons: [0V0 _ <br /> How Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> _�� �'es El No bct c//r�,� 7, <br /> ❑Other(see attached) ❑Yes No <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, broken wavers,etc.?If so, explain in comments below. <br /> Tank#1 ❑ Yes No Tank#2 ❑ Yes l to Pump Tank ❑ Yes 0-No System 1_Mound <br /> ❑ Structural integrity ElStructural integrity ❑ Structural integrity <br /> ❑ Risers ❑ Risers leaking ❑ Elevated drainfield <br /> Cl Risers leaking leaking❑ Baffles ❑ Baffles ❑ Baffles 0 Pressure bed <br /> ❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues 0 Trenches <br /> Non-domestic waste ❑ Ponding/Surfacing <br /> El Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes 0 No <br /> Comments: -�- h-4 CG v-.e n-e e.e4 7� PR- re,P 11r_a w►.e.4 t....a,,..3..�-- <br /> t5 � <br /> �,, t b e leipoeLs t h — <br /> Disposal: ❑ Land Application: Nastewater Treatment Plant v. ._.AT/L--i,-,.. <br /> Disposal Site: I Lime: Gallons Plowed: ❑ Yes ❑ No <br /> Time: <br /> Temperature: pH: >12 ❑ <br /> Time: <br /> Temperature: pH: >12 ❑ <br /> « .ii �. .Jr4.11P.r.a� C THANKS! C .ll ....",.,,",4A11a <br /> 1`_/ ' " `..,* <br /> �"t `^mil s i _�_ <br />