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Jim Eicher Maintenance Inspection Form <br />MPC Lic. #L4286 <br />Maintainer Jim <br />Nick <br />D 0 Sam <br />Septic Service, LLC ® Phone: 763-497-2764 <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 a Email: duaneseptic@centurylink.net <br />DATE INVOICE <br />Pumping Fee: Name: �, -(_ vl� c f V C <br />ch <br />Long Pull Fee: Address: <br />Other Repairs: City/State/Zip:: <br />Total Cost of Servic( Payment Method: ❑ Check Cash Credit <br />✓ the Tank leaks above the Maintenance hole cover is damaged, <br />Tank (check if pre cracked, unsecured, or appears to be <br />designed operating depth designed operating depth <br />structural) unsound <br />Septic/holdin Tank #1 <br />Gallons: ZZ❑ Yes No ❑ Yes No ❑ Yes No <br />❑ Septic/holding Tank #2 <br />❑Yes ElNo ❑Yes ElNo El Yes ElNo <br />Gallons: <br />❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br />Gallon . <br />Pump Tank ❑ Yes ZN ❑ Yes 45<o ❑ Yes No <br />Gallons: 16W <br />How Accessed: Maintenance Hole <br />❑ Other (see attached) <br />Scum/Sludge Measured <br />T ❑ Yes o <br />Mainte:an HH les Securely Replaced: <br />❑.k`�s ❑ Nc <br />Reason For Pumping: <br />i�4 <br />Did you idenoperational issues or unsafe conditionshile assessing the sewage tanks in this system, i.e., <br />rkarl ranks. missino haffles. broken ems, etc. ? If so, explain in comments_a01& D: <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non -domestic waste <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: e Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />