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Jim Eicher Maintenance Inspection Form <br /> i, MPCA Lic. # 654 <br /> '♦* Maintainer f1 Jim <br /> `- ,� <br /> r� I I Duane <br /> pi V� IES I I Nick <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE INVOICE <br /> Pumping Fee: Name: _ <br /> Long Pull Fee: Address: <br /> Other Repairs: City/State/Zip: <br /> bcvilU <br /> Total Cost of Service: Payment Method: ❑ Check LI Cash ❑ Credit <br /> • <br /> Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, <br /> Tank(check if present) designed operating depth designed operating depth cracked,unsecured,or appears to be <br /> structurally unsound <br /> ü Septic/holding Tank#1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Gallons: <br /> ❑ Septic/holding Tank#2 <br /> Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes LC No <br /> ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes 0 No ❑ Yes ❑ No <br /> Gallons: <br /> ❑ Pump Tank ❑ Yes 0-No ❑ Yes ❑" No 0 Yes ❑ No <br /> Gallons: <br /> How Accessed:❑Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> ❑Other(see attached) ❑Yes ❑ No ❑ Yes ❑ No <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 E'No Tank#2 ❑ Yes 0 No Pump Tank ❑ Yes 0 No System <br /> ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity D Mound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles El Baffles ❑ Baffles ❑ Pressure bed <br /> LI Non-domestic waste 0 Non-domestic waste ❑ Electrical issues ❑ Trenches <br /> LI Non-domestic waste ❑ Ponding/Surfacing <br /> ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? 0 Yes 0 No <br /> Comments: <br /> Disposal: 0 Land Application: ❑Wastewater Treatment Plant <br /> Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br /> Time: Temperature: pH: >12 ❑ <br /> Time: Temperature: pH: >12 ❑ <br /> r,� Q. THANKS! , ��. �� <br /> ,../116 . .sem. -../`� ,�' r`s✓"• .sem. <br />