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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 />4' 1 — 7 J <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />.�NNick <br />® Phone: 763-497-2764 <br />® Email: duaneseptic@centurylink.net <br />INVOICE <br />Um il % — <br />PumpingFee: <br />Name:7S <br />4-cue, <br />Long Pull Fee: <br />Address: .3-3S S iLvg4 <br />(oL,/ °"'V. <br />Other Repairs: <br />City/State/Zip: <br />6 ro vA_D <br />Total Cost of Se rv' <br />Payment Method: ❑ Check <br />❑ Cash ❑ Credit <br />Maintenance hole cover is damaged, <br />Tank (check if pre <br />aks 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 />eptic/holding Tank #10 <br />El Yes <br />CR'14o <br />El Yes �J—No <br />El Yes <br />Gallons: t <br />_. Septic/holding Tank #2 <br />El Yes <br />(�oN <br />❑Yes No <br />❑Yeso <br />Gallons: t �� <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />i.�-t'ump Tank <br />❑Yes <br />®'No <br />❑Yes �No <br />ElYes <br />Gallons: ts'�© <br />How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) Eg'Yes El No 2- es ❑ No A/1.c, iVill <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />.,r.• 9 rr en [n ;n in rnmmPntc bp..lnw. <br />Tank #1 El Yes No <br />Tank #2 ❑ Yes o <br />Pump Tank El No <br />System <br />❑ Structural integrity <br />El Structural integrity <br />El Structural integrity <br />und <br />El Elevated drainfield <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />El bed <br />❑ Baffles <br />❑ Non -domestic waste <br />El Baffles <br />❑ Non -domestic waste <br />El Baffles <br />ElElectrical issues <br />❑Trenches <br />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: ®'Wastewater Treatment Plant (vim <br />Disposal Site: Lime: Gallons 39,-7-p Plowed: <br />Time: Temperature: pH: <br />Time: Temperature: pH: <br />❑ Yes ❑ No <br />>12 ❑ <br />>12 ❑ <br />PW man <br />x m! <br />( �• �' 1 <br />