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Jim Eicher <br />A <br />Septic Service, LLC <br />1205 LaBeaux Ave <br />St. Michael, MN 55376 <br />n AT= 5z' 7, a -2 3 <br />Maintenance Inspection Form <br />MPca IL4286 <br />Maintainer Jim <br />J Duane <br />C'Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />1Nvnit^F <br />Pumping Fee: 3.7 ` <br />Name: �- � t 5 <br />� <br />Long Pull Fee: <br />Addres <br />�Z2�o <br />� <br />ev► <br />� � <br />Other Repair <br />, 29 <br />City/State/Zip: <br />Total Cost of Servi <br />Payment Method: 076heck ❑ Cash <br />❑ Credit <br />.� <br />Yq �— <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 />Septic/holding Tank #1 <br />❑ Yes .e''� <br />�— <br />El Yes 13 No <br />❑ Yes <br />Cho <br />Gallons: g�� <br />Septic/holding Tank #2 <br />/ ❑ Yes C3 No <br />�- <br />❑ Yes ©-N"o <br />❑ Yes <br />0" No <br />Gallons: <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />ER"P"u Tank <br />❑ Yes ff No <br />❑ Yes 2' No <br />❑ Yes <br />.®'Iqo <br />Gallons: q 0 0 <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance oles Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />es ❑ No <br />®'Yes ❑ No�' <br />Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, Le., <br />oFarllPfl tanlec mieeinn h gff7Pc_ hmiep..n rnvpm. Ptr.7 If SO. PXDIaln In comments -below. <br />Tank #1 ❑ Yes JOINo <br />Tank #2 ❑ Yes 9,fl o <br />Pump Tank ❑ Yes Erno <br />System <br />❑ Structural Integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfieid <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: LiLarld Application: ❑ Wastewater Treatment Plant <br />Disposal Site: `1 <br />Lime: <br />Gallons Z rOO <br />Plowed: <br />❑ Yes <br />EWo <br />Time: p 2 <br />Temperature: ( 7. YpH: <br />2.'L_ <br />> 12 B" <br />Time: y <br />Temperature: ( ey. :5r <br />pH: <br />I Z,, Z,, <br />> 12 0' <br />wswim � I I <br />v WMENJI� W-P., <br />Raw�-1. �''" sue- '0000 �- � s�- <br />