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Jim Eicher Maintenance Inspection Form <br /> 4MPCA Lic. #654 <br /> • <br /> � � Maintainer i I Jim <br /> tii 1 Duane <br /> ► i * ick <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE (4a- f a-Z. INVOICE <br /> Pumping Fee: Name: <br /> 3 7 S`.- L z4'5\s'''N L.me.... <br /> Long Pull Fee: Address: 094 ' ir a <br /> ot , <br /> Other Repair City/State/Zip: <br /> Total Cost of Se -------- <br /> ._.__------7- , <br /> Payment Method: ❑ Check ❑ Gash ❑ Credit <br /> 4 9‘,3-,0-40' } <br /> Tank(check ifpresent) Tank leaks below the Tank leaks above the <br /> Maintenance hole cover is damaged, <br /> designed operating depth designed operating depth cracked,unsecured,or appears to be <br /> structurally unsound <br /> eptic/holding Tank#1 —� <br /> Gallons: El Yes C31"'IVo ❑ Yes 1"<O El Yes 1L�No <br /> ,�' G- v <br /> Er eptic/holding Tank#2 /" �` <br /> Gallons: c 9_ CI Yes -Er-NO- ❑ Yes C'"No ❑ Yes C9'No <br /> ❑ Pretreatment Tank ❑ Yes 0 No ❑ Yes 0 No ❑ Yes ❑ No <br /> Gallons:lo� <br /> l�'Pump Tank /� <br /> Gallons: A ❑ Yes No ❑ Yes Q No ❑ Yes [�•'� <br /> v 0'D <br /> How Accessed:1 l Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> ❑Other(see attached) ❑Yes 13i Er es ❑ No l,,vtex,.tA,.L- <br /> Old you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system, i.e,, <br /> cracked tanks,missing baffles, broken covers,etc.?If so, explain In comments below. <br /> Tank#1 0 Yes10 Tank#2 ❑ Yes 10 Pump Tank ❑ Yes o - System <br /> ❑ Structural integrity ❑ Structural integrity _ ❑ Structural integrity 2i ound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> ❑ Non-domestic waste 0 Non-domestic waste El Electrical issues ❑ Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> ❑ Effluent Filter/screen 0 Other: <br /> Cleaned? 0 Yes 0 No <br /> Comments: i 11 41 C-7 E)ticoer,O <br /> Disposal: land Application: ❑Wastewater Treatment Plant <br /> Disposal Site: 'VA Lime: / Gallons j0-0 Plowed: ❑ Yes 12-1Co <br /> Time: i t,p Temperature: L V. V pH: E-a_Lf >12 <br /> Time: 1 t14P Temperature: 1 5-; 3 pH: 1 z y >12 . <br /> ,,, ..., 0111;-% / .0$m k4°1—* C .fi�THANKS! 41 , <br /> .- w ,,,,��., \\• , •�..,, `�'/ am _ m. <br /> ."grigvv <br /> ,.,"'" .x�. -' xrrRc <br />