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Jim Eicher Maintenance Inspection Form <br />MP Lic. #L4286 <br />Maintainer Jim <br />Nick <br />p 0 Sam <br />Septic Service, LLC • Phone: 763-497-2764 <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 •Email: duaneseptic@centurylink.net <br />DATE -1"_I6-2� INVOICE <br />Pumping Fee: Name: M d j z h f Ut A <br />Long Pull Fee: Address: <br />Other Repairs: l City/State/Zip: <br />Total Cost of Ser ❑ Check ❑ Cash Credit <br />Maintenance hole cover is damaged, <br />ik leaks below the the cracked, unsecured, or appears to be <br />Ta k (check i ned operating depth designed operating depth <br />structural) unsound <br />Septic/holdin Tank #1 ❑ Yes No ❑ Yes ❑ Yes No <br />Gallons:tvvjl <br />2'gelpfic/holdin Tank #2 ❑ Yes gr-No— ❑ Yes elNo ❑ Yes ' No <br />Gallons: OW <br />❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br />Gallons: <br />�ump Tank ❑ Yes Fei o JO; El Yes 4�1 No ❑ Yes No <br />Gallons: luvo <br />How Accessed: aintenance Hole Scum/Sludge Measureed Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) El Yes Cl'No ®"des ❑ No <br />Did you identify operational issues or unsafe conditions while assessing the sewage tanks in this system, i_e., <br />acked tanks, missing baffles, broken c s, etc.? If so, explain in comments be <br />Tank #1 ❑ Yes o Tank #2 ❑Yes o Pump Tank ❑ Yes ❑ System <br />❑ Structural integrity ❑ Structural integrity ❑ Structural integrity Mound <br />❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br />❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br />❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑Trenches <br />❑ Non -domestic waste ❑ Ponding/Surfacing <br />❑ Effluent Filter/screen ❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Disposal: ; O--Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: 1 , { Lime: J <br />Gallons - Plowed: ❑ Yes El No <br />Temperature: pH: > 12 ❑ <br />Time: <br />Time: <br />Temperature: pH: > 12 El <br />