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Jim Eicher <br />a� <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />-n '7 1 911 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />lick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />INVOICE <br />UHIC f —JI_— I <br />Pumping ree: 2 <br />Name: <br />Long Pull Fee: <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />G <br />Total Cost of Se e: <br />Payment Method: ❑ Check <br />❑ Cash ❑ Credit <br />TO <br />3-0 <br />Maintenance hole cover is damaged, <br />Tank leaks below the <br />Tank leaks above the <br />cracked, unsecured, or appears to be <br />Tank (check if present) <br />designed operating depth <br />designed operating depth <br />structural) unsound <br />Septic/holding Tank #1 <br />El Yes <br />�'TQo <br />❑Yes !]-fde- <br />El Yes No <br />Gallons: t2fv <br />Septic/holding Tank #2 <br />❑Yes <br />❑ No <br />❑Yes ❑ No <br />El No <br />Gallons: t 250 <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Pump Tangy <br />❑Yes <br />No <br />❑Yes No <br />❑ Yes 10 <br />2> <br />Gallons: 1� <br />-low Accessed: aintenance Hole Scum/SSiudge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) e'Y-es ❑ No u Yes El No itv <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />eked tanks, missing baffles, brokegpovers, etc.? If so, explain in comm en Blow. <br />Tank #1 o Tank #2 ❑ Yes No Pump Tank ❑ Yes n No System <br />❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ound <br />❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br />❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br />❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches <br />❑ Non -domestic waste ❑ Ponding/Surfacing <br />❑ Effluent Filter/screen ❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />� Lt <br />Disposal: ❑ Land Application: Rr<astewater Treatment Plant <br />Gallons `�`� Plowed: ❑ Yes ❑ No <br />Disposal Site: Lime: �� <br />Time: Temperature: pH: > 12 ❑ <br />Time: Temperature: pH: > 12 ❑ <br />