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Jim Eicher <br />kkD <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />D Duane <br />lick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />V/11 G / - — - — - <br />Pumping Fee: <br />Tank #2 ❑ Yes o Pump Tank ❑ Yes ❑ No <br />Name: <br />❑ Structural Integrity <br />❑ Stru refihtegrity ❑ Structural integrity <br />3 75 - <br />0 Risers leaking <br />&. 13✓v 14. <br />❑ Pressure bed <br />❑ Baffles <br />❑ Non-domestic waste <br />Long Pull Fee: <br />Trenches <br />Addre�:(0'YO . <br />" 'I r - <br />❑ Ponding/Surfacing <br />�ther: <br />❑ Effluent Fllter/screen <br />✓& <br />- <br />Cleaned? ❑ Yes ❑ No <br />Other Repairs: <br />Comments: <br />Ir z ! SY S�e V, <br />City/State/Zip: <br />Total Cost of Service: <br />iC <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Maintenance hole cover Is damaged, <br />Tank (check If present) <br />Tank leaks below the <br />Tank leaks above the <br />cracked, unsecured, <br />or appears to be <br />designed operating depth <br />designed operating depth <br />structurally <br />unsound <br />❑TSept`c/holding Tank #1 <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: t L,�_Z <br />❑optic/holding Tank #2 <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: t Zoo <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />O-Ffiump Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: t Z�—Q <br />How Acce ed: ❑Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reams For Pumping: <br />❑ Other tached) ❑Yes ❑ No ❑Yes ❑ / ,tr <br />Did you identify any opera l_' l Issues or unsafe conditions whlle a�S the sewage tanks in this system, <br />._ .- _nir 7 iF_ ovnlaln In rnmments below. <br />Tank #1 ❑ Yes ❑ No <br />Tank #2 ❑ Yes o Pump Tank ❑ Yes ❑ No <br />System <br />❑ Structural Integrity <br />❑ Stru refihtegrity ❑ Structural integrity <br />❑ Mound <br />❑ Elevated drainfleld <br />0 Risers leaking <br />isers leaking rs leaking <br />-Baffles ❑ Baffles�Iss <br />❑ Pressure bed <br />❑ Baffles <br />❑ Non-domestic waste <br />0 <br />❑Non domestic waste ❑Electrica❑ <br />Trenches <br />pH: 1 Z . ( <br />❑ Non-domestic wase <br />❑ Ponding/Surfacing <br />�ther: <br />❑ Effluent Fllter/screen <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Ir z ! SY S�e V, <br />nicnnsal- aCand Aoolicatlon: ❑ Wastewater Treatment Plant <br />)isposal Site: Ll I Lime: <br />Gallons 2 Zs� <br />Plowed: ❑ Yes <br />❑ No <br />Fime: 1010 <br />Temperature: p <br />pH: 1 Z,1 <br />> 12 <br />F9' <br />time: 1 0 yu <br />Temperature: "? 1 <br />pH: 1 Z . ( <br />> 12 <br />Cr <br />