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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer = Jim <br />[Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />..... _V <br />Pumping Fee: <br />Name: 3 <br />Long Pull Fee: <br />Address: <br />l ! oS <br />e th,ys �r - <br />Other Repairs: \ -, <br />t` GS V L Z L LcJ r� <br />City/State/Zip: <br />U-19 t/�-o <br />Total Cost of Service: - <br />- - <br />�wV_ <br />Payment Method: ❑ Check El Cash ❑ Credit <br />Maintenance hole cover is damaged, <br />Tank (check if prese <br />T eaks 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 />[I"Septic/holding Tank #1 <br />❑Yes No <br />El Yes �o <br />El Yes �o <br />Gallons: (2s� <br />Septic/holding Tank #2 <br />❑ Yes Z No <br />❑ Yes p No <br />❑ Yes Z No <br />Gallons: l 2S-' <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />C--(Pump Tank <br />/ <br />❑ Yes 4!5 No <br />❑ Yes D No <br />❑ Yes of No <br />Gallons: <br />How Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) 1I Yes ❑ No Zf Yes ❑ No /VLG L''f <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />­__ ti.,.1.,.., a atr 7 Tf — avnlaln in rnmments,below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes No <br />Pump Tank El No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Risers leaking <br />En Mound <br />❑ Elevated drainfield <br />❑ Risers leaking <br />❑ Baffles <br />❑ Risers leaking <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non -domestic waste <br />❑ Non -domestic waste <br />❑ Electrical issues <br />❑ Non -domestic waste <br />❑ Trenches <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: Sr. �o F Lis L Cc �e <br />w Ke �- S 4 c� G l <br />ervvw ti <br />w �� k �,►,, o v c�ttis� dl.�, t�..-��,c. ...1-a sY s ��'• _ <br />nisnnsal: ❑ Land Aoolication: r_1 Wastewater I reatment runt w <br />Disposal Site: <br />Lime: <br />Gallons2 (0.c.,-0 <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 0 <br />