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Jim Eicher <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE <br />Maintenance <br />Maintainer <br />• Phone: 763-497-2764 <br />Inspection Form <br />MPCA Lic. #L4286 <br />ElJim <br />❑ Nick <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: -, -, - <br />Scum/Sludge Measured <br />Name: r* <br />Long Pull Fee: <br />❑ Other (see attached) <br />Address: <br />❑ Yes ❑ No <br />❑ Mound <br />❑ Risers leaking <br />Other Repairs: r <br />❑ Risers leaking <br />City/State/Zip: <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />Total Cost of Service: j <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally unsound <br />❑ Septic/holding Tank #1 <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Septic/holding Tank 42 <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Pump Tank <br />Gallons: <br />❑ Yes ❑ No <br />ElYes ❑ No <br />❑ Yes ❑ 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 />❑ Mound <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: -Enand Application: ❑ Wastewater Treatment Plant <br />Disposal Site: w , <br />Lime: <br />Gallons 2_6 o U <br />Plowed: <br />❑ Yes —0 -No <br />Time: 3 ', t ?) <br />Temperature: <br />pH: i .: <br />- > 12 -❑ <br />Time: {4 , 3 <br />Temperature: <br />pH: <br />> 12 ❑ <br />,✓~-'�-� �`'- .sem- ,�-'�-� �`'� sem.. <br />