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Jim Eicher Maintenance Inspection Form <br /> MPCA Lic. # 654 <br /> .4 <br /> Alb Maintainer I I Jim <br /> -- `'' '��� � I l Duane <br /> DIPA <br /> L$ ! , Nick <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE S i- 2 3 INVOICE <br /> Pumping Fee: 4 3. v Name: 4 J ."_, A 1,-`3a.-1 <br /> Long Pull Fee: Address: <br /> r6C3s ,..54 f1 ,4,; 54-. <br /> Other Repairs 'City/State/Zip: <br /> ...0 t...-me <br /> Total Cost of Service: Payment Method: LI Check ❑ Cash ❑ Credit <br /> t-Ae,.3—,cx, <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 /> P"Septic/holding Tank#1 ❑ Yes ErN CI Yes ❑No ❑ Yes C 1-11- <br /> Gallons: !-- <br /> ❑rSelo�pticlholding Tank#2 ❑ Yes 24 ❑ Yes C-1"No ❑ Yes 13-1vo <br /> Gallons: •73 o <br /> El Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes Cl No <br /> Gallons: <br /> ❑P p Tank ❑ Yes o ❑ Yes Er No ❑ Yes f2 <br /> Gallons: /0,9- <br /> How Accessed:" Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> El Other(see attached) ❑Yes J.;hvo ©'‘s ❑ No j' c.= " <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 covers,etc.?If so, explain in comment elow. <br /> Tank#1 ❑ Yes Iff—No Tank#2 ❑ Yes Ca''IGo Pump Tank ❑ Yes No System <br /> El Structural integrity ❑ Structural integrity El Structural integrity lend <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> El Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑Trenches <br /> ❑ Non-domestic waste Cl Ponding/Surfacing <br /> • ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? 0 Yes ❑ No <br /> Comments: <br /> Disposal: ❑ Land Application: i2'Wastewater Treatment Plant LmkK„ `-''t <br /> Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br /> Time: Temperature: pH: >12 ❑ <br /> Time: <br /> Temperature: pH: >12 ❑ <br /> ` e - t � THANKS! . +l.,t 4' / ` <br />