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Jim Eicher <br />DVANE*� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE (9 - 2-5" <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />1prNick <br />= Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />trvvnir_F <br />Pumping Fee: 1 _ <br />_ <br />Name: <br />Long Pull Fee: <br />lti <br />Address: <br />3 ya�o <br />s-}' <br />Other Repairs: <br />\ <br />City/State/Zip: <br />Total Cost of S <br />[ <br />Payment Method: El Check ❑ Cash <br />El Credit <br />40(A <br />Tank (check if pre <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />, crackedunsecured, or appears to be <br />designed operating depth <br />designed operating depth <br />structural) <br />unsound <br />Septic/holding Tank #1 <br />Gallons: l Z <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Septic/holding Tank #2 <br />Gallons: <br />ElYes ElNo <br />ElYes ElNo <br />❑ Yes <br />ElNo <br />❑ Pretreatment Tank <br />Gallons: <br />El ElNo <br />❑ Yes ❑ No <br />ElYes <br />ElNo <br />❑ Pump Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />How Accessed: ❑ Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />-T-4. Vk !C <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 covers, etc.? If so, explain in comments below. <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: 1--Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons P 1—sx_9 <br />Plowed: <br />❑ Yes <br />2-,M"o <br />Time: <br />Temperature: j —1 j <br />pH: <br />Z_ 3 <br />> 12 <br />Time: 2 S S <br />Temperature: j _ <br />pH: <br />Za 3 <br />> 12 <br />