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Jim Eicher <br />in <br />D a <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />r � 2 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />dick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />U F11 L l "- a - i <br />Pumping Fee: <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes o System <br />Name - <br />❑ Structural integrity <br />❑ Structural integrity Lei Mound <br />❑ Elevated drainfield <br />❑ Risers leaking <br />c9� <br />❑ Risers leaking <br />❑ Pressure bed <br />❑ Baffles <br />❑ Non-domestic waste <br />❑ Baffles <br />❑ Non-domestic waste <br />❑ Baffles <br />❑ Electrical issues ❑ Trenches <br />Long Pull Fee: <br />❑ Non-domestic waste ❑ Ponding/Surfacing <br />Address: <br />1� <br />� O ✓1 <br />Other Repairs: <br />Cleaned? ❑ Yes ❑ No <br />City/State/Zip: <br />Total Cost of Service: <br />Payment Method: El Check El Cash <br />El Credit <br />`� <br />T <br />�� `{S- C� <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 />structural) unsound <br />Septic/holding Tank #1-'- <br />No <br />El Yes Jo <br />❑Yes <br />No <br />Gallons: <br />Gallons: � Z�cs <br />P-S<`eptic/holding Tank #2 <br />❑ Yes <br />No <br />❑ Yes Id' No <br />❑ Yes <br />Gallons: t Zj0 <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />®'Pump Tank <br />❑ Yes <br />❑'No <br />❑ Yes <br />❑ Yes <br />❑to <br />Gallons: t ZS"b <br />How Accessed: aintenance Hole Scum/Sludge Measured Maintena/nce� Holes Securely Replaced: Reason For Pumping: <br />ElOther (see attached) l�Yes ❑ No �J Yes ❑ No v'K <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks /n this system, i.e., <br />ti_.. i.,... ,. nf. 7 rf en avn/ain in rnmment5 below. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes o System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity Lei Mound <br />❑ Elevated drainfield <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Pressure bed <br />❑ Baffles <br />❑ Non-domestic waste <br />❑ Baffles <br />❑ Non-domestic waste <br />❑ Baffles <br />❑ Electrical issues ❑ Trenches <br />❑ Non-domestic waste ❑ Ponding/Surfacing <br />❑ Effluent Filter/screen ❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: ,,rwastewater Treatment Plant <br />Disposal Site: Lime: Gallons Z.1_0 0 Plowed: ❑ Yes ❑ No <br />Time: Temperature: pH: >12 ❑ <br />Time: Temperature: pH: >12 0 <br />