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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />°1_1 1 - 7 < <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />-Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Lim I G <br />Pumping FE <br />Name: t S <br />• k� <br />Long Pull F <br />Address: �.-7 D <br />Other Repa <br />City/State/Zip: <br />Total Cost c <br />Ci v� <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank leaks above the <br />designed operating depth <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Tank leaks below the <br />Tank (c designed operating depth <br />eptic/holding Tank #1 <br />Gallons: �g,� <br />eptic/holding Tank #2 <br />Gallons: ( o 9✓� <br />El Yes ❑ <br />El Yes C�' No <br />El Yes �o <br />❑Yes l� No <br />El Yes No <br />El No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />ump Tank <br />Gallons: LQoo <br />❑Yes VIVO <br />❑Yes No <br />_/ <br />❑Yes -LI No <br />How Accessed: ❑ Maintenance Hole <br />❑ Other (see attached) <br />Scum/Sludge Measured <br />fl Yes ElNo <br />Maintenance Holes Securely Replaced: <br />es ❑ No <br />Reason For Pumping: <br />�t-`�-�� �4- <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />racked tanks, missing baffles, broken c vers, etc.? If so, explain in comment elow. <br />#1 ❑ Yes No I Tank #2 ❑ Yes o Pump Tank ❑ Yes C No Syste <br />❑ Structural integrity Mound <br />❑ Structural integrity <br />❑ Risers leaking <br />❑ Structural integrity <br />❑ Risers leaking <br />❑ Risers leaking <br />El Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑Baffles <br />❑ Pressure bed <br />[I Trenches <br />❑ Non -domestic waste <br />El Non -domestic waste <br />ElElectrical issues <br />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />cleaned? ❑ Yes ❑ No <br />Comments: -(`� �jr� C�u�e-S J'Z A <br />s��« <br />Disposal: ❑ Land Application: i�astewater Treatment Plant\-�'K''_ <br />Disposal Site: Lime: Gallons -2w Plowed <br />Time: Temperature: pH: <br />Time: Temperature: pH: <br />"r &_- <br />❑ Yes ❑ No <br />>12 ❑ <br />>12 ❑ <br />