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Jim Eicher <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />ick <br />� <br />Sam <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />- Phone: 763-497-2764 <br />St. Michael, MN 55376 <br />- Email: duaneseptic@centurylink.net <br />II" 25- z <br />DATE <br />INVOICE <br />Pumping Fee: <br />Name: € , rv,, S P6, VVx <br />Long Pull Fee: <br />Address: _��-- l� f- (._. <br />( <br />� r ,AOther <br />Repairs: <br />City/State/Zip: <br />6m) <br />Total Cost of Sear e: <br />FOyment Method: ❑ Check ❑ Cash ❑ Credit <br />�f� <br />iLesc_, <br />he <br />Tank leaks above the Maintenance hole cover is damaged, <br />Tank (check <br />-- — esigne operating depth <br />designed operating depth cracked, unsecured, or appears to be <br />structural) unsound <br />El"Septic/holding Tank #1 <br />Gallons: , s <br />El Yes o <br />�— <br />❑Yes ❑' No <br />El Yes <br />peptic/holding Tank #2 <br />,�~ <br />Yes No <br />Yes <br />Gallons: ; , a.s� <br />El Yes ®No <br />❑ <br />❑ 040 <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />E� ump Tank <br />❑ <br />❑Yes <br />❑Yes <br />Gallons <br />Yes o <br />�No <br />❑ No <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />s ❑ No <br />+� Yes ❑ No <br />�1 , <br />Did you identify -any, operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />wracked tanks, missing baffles, broken covers, etc.? If so, explain in comments, below. <br />Tank #1 ❑ Yes ❑ No <br />Tank #2 ❑ Yes C]�No <br />Pump Tank El Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <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: <br />Disposal: ❑ Land Application: ce-ga-stewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons y �, ,,<� �s �;� <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />W��,� •� , Q� J' �i`'.-.� cam'' ,,,� ��1,r •� <br />�,.'� �'',,--s�...� ,✓�-� � .sue. <br />