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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. # 654 <br />Maintainer O Jim <br />D Duane <br />Nick <br />IT <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Pump Tank ❑ Yes No <br />Name; <br />❑ Structural integrity ❑ Structural integrity <br />Long Pull Fee: <br />7i� c9 -O <br />Mound <br />❑ Elevated drainfield <br />O Risers leaking ❑ Risers leaking <br />Address: <br />3q 6-s- <br />6 -le- 4et- <br />a A le rA <br />Other Repairs: <br />❑ Pressure bed <br />❑ Non-domestic waste ❑ Non-domestic waste <br />City/State/Zip:� <br />A, <br />❑ Non-domestic waste <br />Total Cost of Service:i <br />�� <br />Payment Method: <br />❑ Check <br />❑ Cash ❑ Credit <br />.0-0 <br />O tit <br />Maintenance hole cover Is damaged, <br />Tank (check if present) <br />Tank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally unsound <br />Septic/holding Tank #1 <br />E3Yes <br />No <br />❑ Yes <br />0-90 <br />❑ Yes R_1T0 <br />Gallons: j ra.¢-o <br />[; S ptic/holding Tank #2❑Yes <br />❑Yes <br />p' leo <br />❑ Yes ❑ <br />Gallons: jv CO <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />Gallo s: <br />Pump Tank <br />❑ Yes <br />Q No <br />❑ Yes <br />0--N a <br />❑ Yes <br />11-00 <br />Gallons: � <br />-iow Accessed: ElMaintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) 1 ❑ Yes ❑ No ❑ Yes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, I.e., <br />— i ror— ­i.i. In rnm monfc hpinw. <br />Tank #1 ❑Yes o Tank #2 ❑Yes No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity ❑ Structural integrity <br />❑ Structural integrity <br />Mound <br />❑ Elevated drainfield <br />O Risers leaking ❑ Risers leaking <br />❑ Risers leaking <br />Time: t63 <br />❑ Baffles ❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste ❑ 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 />Disoosal: E -Land Application: ❑ Wastewater I reatment rlani <br />Disposal Site: I Urne: <br />Gallons 7 100 <br />Plowed: ❑ Yes <br />-e No <br />Time: <br />Temperature: (oS <br />pH: jL, 3 <br />> 12 <br />Time: t63 <br />Temperature: fF, 6 <br />pH: 17 -3 <br />> 12 <br />,..�-�`--•. ,�`'� sem- ,_/.` �' <br />