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Jim Eicher <br />4- <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE <br />11;) Is— <br />Cost of Service: <br />Tank (check if present) <br />t Septiclholding Tank #1 <br />Gallons: 1 Z:D <br />0-Septic/holding Tank #2 <br />Gallons:I , 5–L <br />❑ Pretreatment Tank <br />Gallons: <br />Imp Tank <br />Gallons: t t) <br />Maintenance inspection Form <br />MPCA Lic. # 654 <br />Maintainer"Jim <br />0 Duane <br />Ej Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Name: I <br />Address: <br />1360 <br />o x 57 <br />City/state/Zip: <br />TA ig114 C e,—C. <br />Payment Method: Cl Check -[]Cash ❑ t <br />Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, <br />designed operating depth designed operating depth cracked, unsecured, or appears to be <br />structurally unsound <br />Yes o ❑ Yes E wo i ❑ Yes i <br />❑ Yes <br />I No <br />❑ Yes <br />LR–No <br />❑ Yes <br />D--IQo <br />❑ Yes <br />'❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ Yes 11-1io 1 ❑ Yes L_1 <br />�kccessed:i taintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced; Reason For Pumping: <br />❑ Other (see attached) ❑ Yes C7' No ❑ e r ❑ No 5 e <br />Did you Identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />Wicked tanks, missing baffles, broken Viers, etc.? if so, explain In comments . �iow. <br />#1 ❑ Yes No Tank #2 ❑ Yes E!No Pump Tank ❑ Yes o System <br />❑ structural integrity ❑ Structural integrity ❑ Structural integrityLT-Mound <br />D Risers leaking ❑ Risers leaking ❑ Risers leaking 0 Elevated drainfield <br />a Baffies ❑ 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 />Disposal: ❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br />Time:. Temperature: pH: >12 ❑ <br />Time: _- <br />Temperature: pH: > 12 E <br />