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Jim Eicher <br /> Maintenance Inspection Form <br /> MPC Lic. #L4286 <br /> _AP' Maintainer Jim <br /> x�MAWS ❑ 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 q-, 3•.Rq INVOICE <br /> Pumping Fee: ` .-7,� Name: tmq 4� / p (II <br /> `1J 1/1 ( I <br /> Long Pull Fee: 2� Address: /0o5-- sTu 1s7 PI— <br /> Other Repairs: City/State/Zip: <br /> --)Total Cost of Servic _ Payment Method: 0 Check 0 Cash 0 Credit <br /> 4 Lt 5.___1__Z S:7. <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 unsoundnd <br /> Septic/hold }Tank#1 ❑ Yes -P1 N _ <br /> Jo <br /> o ❑ Yes ❑ Yes l*o <br /> Gallons: /6) <br /> 'Septic/holdin,9 TTank#2 0 Yes No 0 Yes Cf'No 0 Yes No <br /> Gallons: co <br /> ❑ Pretreatment Tank 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No <br /> Gallons: <br /> ump Tank�� 0 Yes �Iv oC.1� <br /> 0 Yes NoLd�No <br /> 0 Yes <br /> Gallons: ( <br /> How Accessed:21Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason F Pumping: <br /> ❑Other(see attached) 0 Yes -lam Yes 0 No <br /> Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br /> car'eked tanks,missing baffles, brokennc `ers, etc.?If so, explain In comments be�lo `.- <br /> Tank#1 ❑ Yes r�tao Tank#2 ❑Yes B'No Pump Tank ❑ Yes ❑- System / <br /> ❑ Structural integrity 0 Structural integrity 0 Structural integrity PrWkound <br /> O Risers leaking 0 Risers leaking 0 Risers leaking 0 Elevated drainfield <br /> O Baffles 0 Baffles 0 Baffles ❑ Pressure bed <br /> ❑ Non-domestic waste 0 Non-domestic waste 0 Electrical issues 0 Trenches <br /> ❑ Non-domestic waste 0 Ponding/Surfacing <br /> ❑ Effluent Filter/screen 0 Other: <br /> Cleaned? 0 Yes 0 No <br /> Comments: <br /> Disposal: 0 Land Application: 0VVastewater Treatment Plant > j,,,Y i v w‘^•. <br /> Disposal Site: Lime: Gallons Plowed: 0 Yes 0 No <br /> Time: Temperature: pH: >12 0 <br /> Time: Temperature: pH: >12 0 <br /> Q. THANKS! 10. ,._ ". I L,.."- • ,— , <br /> Cyr' ,,, ;— k •"'� q .-- e � ►1'/ <br /> , ,--'c-1. s sue. ...r.- �''� sue. <br />