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Jim Eicher <br />RI <br />D ° <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE Dc 'Z7Z <br />Pumping FeeVN <br />:, <br />Lono Pull Fee: <br />rs: <br />Total Cost of S <br />Tank (check if present) <br />Septic/holding Tank #1 <br />Gallons: S D <br />eptic/holding Tank #2 <br />Gallons: Soo <br />❑ Pretreatment Tank <br />Gallons: <br />ump Tank <br />Gallons: Sryc) <br />aintenance Hole <br />❑ Other (see attached) <br />Did you identifY3 o <br />❑ Risers leaking <br />❑ Baffles <br />❑ Non -domestic waste <br />Tank leaks below the <br />designed operating depth <br />❑ Yes No <br />❑ Yes u ivo <br />❑ Yes ❑ No <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer = Jim <br />0 Ni c <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />ame: `l �wGL J <br />ddress: <br />D(-,g V)v <br />Payment Method: ❑ Check <br />Tank leaks above the <br />designed operating depth <br />ElYes 0/< <br />❑ Yes ❑' No <br />Yes ❑ No <br />Cash ❑ Credit <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />structurally unso_u id <br />❑ Yes <br />❑ Yes No <br />❑ Yes ❑ No <br />No <br />I <br />❑ Yes � I <br />❑ Yes � ivu <br />El Yes <br />Scum/Sludge Measured <br />intenance ecurely Replaced: <br />Reason For Pumping. <br />❑ Yes No <br />❑ es ❑ No <br />or unsafe conditions w i essing the sewage tanks in this <br />w• <br />m, i.e., <br />perational issues <br />tanks, missing baffles, broken co <br />etc.? If so, explain in comments <br />o System <br />ik #2 ❑ Yes o <br />Pump Tank ❑Yes <br />ound <br />❑ Structural integrity <br />❑ Structural integrity <br />❑Risers leaking <br />[I Elevated drainfield <br />❑ Risers leaking <br />❑ Baffles <br />❑ Pressure bed <br />[I Baffles <br />El 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 />❑ Land A lication: CiWastewater Treatment <br />Disposal: pp <br />Lime: Gallons <br />Disposal Site: Temperature: <br />Time: Temperature: <br />Time: <br />G THANKS! <br />riT <br />0 <br />Plowed: ❑ Yes ❑ No <br />pH: > 12 ❑ <br />pH: > 12 ❑ <br />