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Jim Eicher <br />I <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />Maintenance Inspection Form <br />IMP A Lic. # 654 <br />Maintainer Jim <br />Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@century]ink.net <br />INVOICE <br />uta � � � - • - <br />Pumping Feer <br />❑ Risers leaking <br />Name: C 6, <br />5 F� <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />Long Pull Fee: <br />❑ Non-domestic waste <br />Address: 2-1 <br />Other Repairs:cc, �� Z�— <br />City/State/Zip: <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />r� itib <br />❑ Effluent Filter/screen <br />Total Cost of Service: <br />Payment Method: ❑Check <br />❑Cash ❑Credit <br />Y <br />5— <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />Tank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Septic/holding Tank #1 <br />❑ Yes o r <br />❑ Yes B-190- <br />❑ Yes e'IV'o <br />Gallons: 1,15--O <br />eptic/holding Tank #2 <br />❑ Yes C-1'IQo <br />❑ Yes 'Euro <br />❑ Yes D -M-0 <br />Gallons: <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />ump Tank <br />❑Yes CYNo <br />❑Yes C3"IQo <br />=�j <br />E03 Yes <br />Gallons: ja Sb <br />How Accessed: ElVaintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pu ping: <br />❑ Other (see attached) ❑ Yes ❑.Alves es ❑ No C e <br />Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system, I.e., <br />cr ed tanks, missing baffles, broken covers, etc.? Ifso, explain in comments below. <br />Tank #1 ❑ Yes o Tank #2 ❑ Yes EkNo Pump Tank ❑ Yes o System <br />1i t if ❑ Structural integrity ❑ Structural integrity OR<und <br />❑ Structura n eg. y <br />O Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Disposal: —'Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: y Lime: Gallons 2 6 Plowed: ❑ Yes •0 -No <br />Time: 'f,' = <br />t �,� Temperature: j ti pH: i 2 . <; > 12--0 <br />Time: ' . 1 Temperature: - l 6, pH: t �. • ` > 12--I! <br />• <br />,�'-'�-1. �`'" .sem. ,✓'�- � <br />