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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />_ `? ,9 -) <­ <br />Maintenance Inspection Form <br />e <br />.#L4286 <br />Maintainer <br />Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumpin^ �,, .. - <br />, .. <br />Name: <br />Long Pi <br />Address: C G l rJ <br />Other R <br />City/State/Zip: <br />,fin <br />Total C( <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />nk (check if present) <br />Tank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />structurally unsound <br />Septic/holding Tank #1 <br />Gall <br />❑ Yes No <br />�:No <br />❑ YesEl <br />Yes No <br />Septic/holding Tank #2 <br />Gallons: <br />El Yes No <br />El Yes No <br />❑Yes �No <br />❑ Wettment Tank <br />Ga <br />❑Yes ❑ No <br />❑Yes ❑ No <br />❑ Yes ❑ No <br />Pump Tank <br />Gallons: <br />El Yes No <br />❑Yes No <br />❑ Yes No <br />How Accessed: aintenance Hole <br />Scum/Sludge Measur <br />Maintenance s Securely Replaced: <br />Reason F r Pumping: <br />❑ Other (see attached) <br />❑ Yes No <br />es ❑ No <br />Did you identify operational issues or unsafe <br />acked tanks, missing baffles, bra <br />Al ❑ Yes No I Tank #2 ❑ Yes <br />❑ Structural integrity <br />❑ Risers leaking <br />❑ Baffles <br />❑ Non -domestic waste <br />Disposal Site: <br />Time: <br />Time: <br />❑ Risers leaking <br />❑ Baffles <br />❑ Non -domestic waste <br />s while assessing the sewage tanks in this <br />s, etc.? ifso, explain in comments <br />Pump Tank ❑ Yes CT"No <br />❑ Risers leaking <br />❑ Baffles <br />❑ Electrical issues <br />❑ Non -domestic waste <br />❑ Effluent Filter/screen <br />Cleaned? ❑ Yes ❑ No <br />Disposal: --❑ Land Application: ❑ Wastewater Treatment Plant <br />Lime: Gallons <br />Temperature: „ <br />Tpmnarature: <br />❑ Elevated drainfield <br />❑ Pressure bed <br />❑ Trenches <br />❑ Ponding/Surfacing <br />❑ Other: <br />Plowed: ❑ Yes --B-Nb <br />pH: 1 2 . S > 12_171 <br />pH: > 12 ❑ <br />