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Jim Eicher <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nwwwraATF "ammm <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer L�j Jim <br />.'Nick <br />0 Sam <br />• Phone: I 63-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: {� <br />� <br />v. <br />Name: <br />\`.f <br />����� <br />Long Pull Fee: <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />f � u CD �. <br />....... <br />Total Cost of Servic <br />-,v <br />Payment Method: <br />❑`Check ❑ Cash <br />❑ Credit <br />/ <br />f f <br />? o <br />i <br />ks <br />below the <br />Tank leaks above the <br />Maintenance hole <br />cover is damaged, <br />Tank (check if present) '- <br />, ,Jankte <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, <br />or appears to be <br />structural) <br />unsound <br />O�Septic/holding Tank #1 <br />❑ Yes <br />0 No <br />❑ Yes <br />❑�No <br />❑ Yes <br />Er o <br />Gallons: , S, <br />C)f,,eptic/holding Tank #2 <br />❑Yes <br />U No <br />❑Yes <br />I❑�o <br />❑ Yes <br />❑ No <br />Gallons: Z <br />I <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />Q/Pump Tank <br />❑ Yes <br />❑` N <br />❑ Yes <br />El No <br />❑ Yes <br />.©' No <br />Gallons: r <br />Haw Accessed: ❑ Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑`Yes ❑ No E] Yes ❑ No Uti +...`,. . <br />Did <br />you identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br />rrarLorf han(rc. miceinn haffles- hrnkP.n C.OVEI"S, etC. 7 If S0, eX0/8in In C0r11rneRt$ belOW. <br />Tank #1 <br />❑Yes <br />❑ No <br />Tank <br />#2 <br />❑Yes Ei'No <br />Pump Tank ❑Yes [�j" No <br />System <br />❑ <br />Structural integrity <br />❑Structural <br />integrity <br />❑Structural integrity"Mound <br />❑ <br />Risers leaking <br />❑ <br />Risers leaking <br />❑ Risers leaking <br />❑ <br />Elevated drainfield <br />❑ <br />Baffles <br />❑ <br />Baffles <br />❑ Baffles <br />❑ <br />Pressure bed <br />❑ <br />Non -domestic waste <br />❑ <br />Non -domestic waste <br />❑ A Electrical issues <br />❑ <br />Trenches <br />❑ Non -domestic waste <br />❑ <br />Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ <br />Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <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. Temperature: pH: > 12 11 <br />