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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />Maintenance Inspection Form <br />MP • A Lic. h L4286 <br />Maintainer F Jim <br />Duane <br />0 Nick <br />• Phone: 763-497-2764 <br />• Email: duanesepticCcenturylink.net <br />INVOICE <br />Pumping Fee. .75— <br />Name: <br />1. <br />t <br />Long Pull Fee: tj 0 <br />Address: L <br />Other Repairs: <br />(� <br />City/State/Zip: <br />C <br />a <br />y <br />Total Cost of Service: ,-- <br />Payment Method: ❑ Check 0 Cash <br />❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked , unsecured, or appears to be <br />designed operating depth <br />designed operating depth <br />structural) <br />unsound <br />Septic/holding dank #1 <br />❑ Yes <br />f!� No <br />❑ Yes <br />❑ Yes <br />No <br />Gallons: <br />® Septic/holding Tank #2 <br />❑ Yes <br />2---N'o <br />❑ Yes d No <br />❑ Yes <br />0"N'o <br />Gallons: 1j <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />t� mp Tank <br />/ <br />/ <br />B'No <br />❑ Yes <br />% <br />2 No <br />Gallons: /�_, <br />❑ Yes <br />®' No <br />❑ Yes <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For umping: <br />❑Other (see attached) <br />❑Yes El❑ <br />No <br />Did you Idendry any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br />,_i,_a #� f, _t«r. h-rfl— h-L-n rnviare -tr 7 rf..cn. axnlain In comments below. <br />Tank #1 ❑ Yes FeMo <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />11 Mound <br />❑ 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 />❑ Pond!ng/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: XWastewater Treatment Plant <br />Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br />Time: Temperature: pH: > 12 ❑ <br />Time: Temperature: pH: > 12 ❑ <br />,✓'-''�---�, ,�`'� sue. �./„''�� �`*�/ .s�- <br />