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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Mich+/ael, MN 55376 <br />Maintenance Inspection Form <br />MPC ic. #L4286 <br />Maintainer Jim <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Lim C p- v- <br />Pumping Fee. �. <br />Name: e7-_.e ( <br />Long Pull Fee: <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />0 <br />Total Cost of Serv' e <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />5 �� �o <br />') <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 <br />�i No <br />❑Yes No <br />❑ Yes ❑ <br />Gallons: <br />Septic/holdin�Tank #2 <br />El Yes <br />I�No <br />❑ Yes 0-No <br />El Yes E No <br />Gallons: L�t✓ <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Rrf—ump Tank <br />� <br />❑Yes 10 / <br />Gallons: 5vo <br />❑ Yes <br />e No <br />❑ Yes <br />How Accessed: Maintenance Hole Scum/Sludge Measured Mainte�na�ncee Holes Securely Replaced: Reason For P mping- <br />❑ Other (see attached) ❑ Yes ❑ No .✓sYes ❑ No <br />Did you identify a y operational issues or unsafe conditigms while assessing the sewage tanks in is system, i.e., <br />acked tanks, missing baffles, broken vers, etc.? If so, explain in commen e/ow. <br />Tank #1 ❑ Yes RIF r4o 1 <br />Tank #2 ❑ Yes ETNo I <br />Pump Tank ❑ Yes M No I <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Risers leaking <br />134ound <br />❑ Elevated drainfield <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Baffles <br />❑ Pressure bed <br />❑ Baffles <br />❑ Non -domestic waste <br />❑ Baffles <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: Lime: Gallons Plowed: ❑ Yes ❑ No <br />Time: Temperature: pH: > 12 ❑ <br />Time: Temperature: pH: > 12 ❑ <br />� THANKS! <br />