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Jim Eicher <br /> Maintenance Inspection Form <br /> MPCA Lic. #L4286 <br /> �, Maintainer El Jim <br /> DUANIS ►:= ick <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Emai . centurylink.net <br /> DATE 4-2(0 - 241 INVOICE <br /> Pumping Fee: Name: /� <br /> V 4 t0 a.S� v.-0 vv,-i i l/H A ls-J� j 1 6—ye 1 �t L -f <br /> Long Pull Fee: Address: <br /> 2180 A 10 ; nryikovi Leky <br /> Other Repairs: City/State/Zip: <br /> 1?,.(A.t . (`,,,--k- _ 3 `-. - (�") <br /> Ls.. L� <br /> I ' <br /> Total Cost of S is t _� Payment Method: ❑ Check ❑ Cash CAI 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 <br /> � � structurally unsound <br /> Sepfic/holding� Tank#1 ❑ Yes Pt"1 o ❑ Yes L(o ❑ Yes u No <br /> Gallons:000 <br /> ?eptic/holding Tank#2 <br /> Gallons:(i c't ❑ Yes 13 No ❑ Yes C-3"No ❑ Yes o <br /> ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Gallons: <br /> (2' ump Tank ❑ Yes L✓t No ❑ Yes ff No ❑ Yes RriClo <br /> Gallons:(oOO <br /> How Accessed:[-lMaintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> ❑Other(see attached) L�'Yes ❑ No Q"Yes ❑ No -1--tA5/+-Cc:,'CO <br /> Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br /> cracked tanks, missing baffles, brokeovers, etc.?If so, explain in commen s below. <br /> Tank#1 ❑ Yes O-1 o Tank#2 ❑ Yes dii No Pump Tank ❑ Yes Q No System <br /> ❑ Structural integrity 0 Structural integrity ❑ Structural integrity Mound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> ❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues 0 Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> 0 Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes ❑ No <br /> Comments: <br /> Disposal: Zrand Application: ❑Wastewater Treatment Plant <br /> Disposal Site: LL3 Lime: Gallons 2 S-\-9-z-1 Plowed: ❑ Yes E ll�o <br /> Time: i o 3 7 Temperature: t 3:) pH: 1 ?.;1 >12 Er <br /> Time: (t 0 7 Temperature: [3. 3 pH: (Z, 41 >12 <br /> e, r . F11111l1 <br /> Q THANKS! . 6. ,,, :-4.A* <br /> i ...* <br /> • "1 '....G W . <br /> .irICWN/ <br /> ,,., `41 -•. re"'.'.sue. -1- .,..-' zc- <br />