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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />n ATP 6 -- Q -A-5— <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />0 Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: • .- <br />Name: <br />Address:�- <br />Long Pull Fee: <br />Other Repairs: <br />City/State/Zip: <br />1_10( <br />OAGi/ <br />Total Cost of Sery <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />designed operating depth <br />designed operating depth <br />structural) unsound <br />eptic/holding Tank #1 <br />�- <br />❑Yes 1 <br />❑Yes d"o <br />�� <br />❑Yes o <br />Gallons: <br />eptic/holding Tank #2 <br />❑ Yes 1ao — <br />El Yes Cho <br />El Yes o <br />Gallons: <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />I <br />ump Tank <br />ElYes No <br />❑ Yes C:l. o <br />Gallons: <br />❑ Yes No <br />How Accessed.:2VIntenance Hole <br />Scum/Sludge M�;�No. <br />Maintenance H s Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes <br />es ❑ No <br />ov7 <br />Did you Identify anperatfonal issues or unsafe conditions while assessing the sewage tanks in this system, I.e., <br />L.' f—Lec miccinn hafflac. hrnkan rn r_.2 if so. exolaln 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 />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 />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: dwastewater 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 />���� are, �y`r �--�.��• -~�'"`y ����, �.s`r` 9,-401- <br />