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Jim Eicher <br />D a <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />—r_-)ter --7e" <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick <br />Sam <br />• Phone: 763-497-2764 �! <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: <br />-� <br />Address: <br />PKv <br />Lon Pull Fee: i <br />9 <br />Other Repairs: <br />City/State/Zip: <br />1 (iu <br />-p J—o <br />'-7L/ kja <br />Total Cost of Se ice <br />ti k <br />Payment Method: ❑ Check <br />❑ Cash ❑ Credit <br />Maintenance hole cover is damaged, <br />Tank (check if present <br />Tank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />�ptic/holding Tank #1 <br />❑ Yes 31 o <br />❑ Yes <br />❑ Yes B—t�to <br />Gallons: l 2-5-0 <br />peptic/holding Tank #2 <br />El Yes XNo <br />El Yes 1�0 <br />El Yes <br />Gallons: �,9� <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />imp Tank <br />❑ Yes C? No <br />❑ Yes 0' No <br />❑ Yes <br />Gallons: t ZrO <br />How Accessed: Elf0ainteriance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) es ❑ No B'Yes ❑ No <br />Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />.. �._.,i,,... aP, J rf cm avnlain in rnmmL..ntS below. <br />Tank #1 ❑Yes o <br />Tank #2 ❑Yes No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Risers leaking <br />ound <br />❑ Elevated drainfield <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Baffles <br />❑ Pressure bed <br />❑ Baffles <br />❑ Non -domestic waste <br />❑ Baffles <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: ❑ Wastewater Treatment riani <br />Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br />Time: Temperature: pH: > 12 ❑ <br />Time: Temperature: pH: > 12 ❑ <br />G o THANKS! a �� <br />G <br />