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Jim Eicher <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 5- Z0, _-S' <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />4rNick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: p t�1. S -f-T <br />1 <br />� ' <br />Long Pull Fee: <br />t <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of SeR <br />71 <br />Payment Method: El Check El Cash <br />Y <br />El Credit <br />`o� <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />k leaks below the <br />Tank (check if <br />ied operating depth <br />designed operating depth <br />structural) unsound <br />�tic/holding Tank #1 <br />Yes <br />-- <br />❑ No <br />t Z Sp <br />3—No— <br />❑ Yes C <br />El Yes No <br />El <br />Septic/holding Tank #2 <br />❑ Yes d No <br />El Yes C�No <br />El Yes <br />n No <br />Gallons: � Lsro <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Pump Tank <br />❑ Yes V, No <br />❑ Yes Ei'No <br />❑ Yes <br />_iJo <br />Gallons: c Zgb <br />How Accessed: PVaintenance Hole <br />Scum/Sludge Measured <br />Maintenance Hales Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) I <br />121" es ❑ No <br />9-Y-e-ss ❑ No <br />�� t <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br />.-*'cracked tanks, missing baffles, broken-c-overs, etc.? If so, explainfn comments below. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes No <br />Pump Tank es ❑ No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <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 />❑ �en-domestic waste <br />❑ Ponding/Surfacing <br />Effluent Filte�4screen <br />❑ Other: <br />Cleaned? CirYes ❑ No <br />Comments: �� + ` �� �� S P ✓ �JI -5=� I I �sL �w } J_ <br />Disposal: ❑ Land Application: Er/Wastewater Treatment Plant LO 4' + %j '' <br />Disposal Site: <br />Lime: <br />Gallons 2 -7 <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 0 <br />VAIV <br />V__ '_ 90 <br />