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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE '6- �- 2 ­�' <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />CO i ick <br />0 Sam <br />• Phone: 763-497-2764 <br />f <br />� �-• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: y 20 <br />�,2 <br />Name: I " I F <br />1 <br />Long Pull Fee: <br />I? <br />Address: p <br />i O S <br />i r, <br />D• of <br />I <br />—I-f -.(. ; / <br />Other Repairs: + (� g <br />City/State/Zip: <br />f7tf oh J <br />Total Cost of S 14: _ <br />-� <br />n � � <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check i nt <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally unsound <br />O'Septic/holding Tank #1 <br />❑Yes <br />ElNo <br />❑Yes ❑ No <br />El Yes ElNo <br />Gallons: LSJ <br />❑ Septictholding Tank #2 <br />❑yes <br />❑ No <br />❑Yes ❑ No <br />❑Yes ❑ No <br />Gallons: <br />PtmentTank <br />Gallons:ons:- � 70 <br />ElYes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />E Pump Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: /o -0 <br />How Accessed:❑ Maintenance HDIe <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />R ason For Pumping: <br />�c <br />❑ Other (see attached) <br />❑ Yes ❑ No <br />C'1 Yes ❑ No <br />"+ St t <br />Did 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 ❑ Yes ❑ No <br />Tank #2 ❑ Yes ❑ No <br />Pump Tank ❑ Yes ❑ No <br />System <br />❑ Structural Integrity <br />❑ Structural Integrity <br />❑ Structural Integrity <br />❑ 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 />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: lj <br />Disposal: ❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />z �r .. i �FQ ® x <br />a_ <br />