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Jim Eicher <br />Septic Service, LLC / <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE '2 - -3 J - Z f <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />Duane <br />['Nick <br />• Phone: 763-497-2764 <br />• Email: cluaneseptic9centurylink. net <br />Pumping Fee: <br />Scum/Sludge Measured <br />Na <br />Reason For Pumping: <br />IIVVVIIa <br />Long Pull Fee: <br />_E�es ❑ No <br />71� Vjtk- <br />Addres <br />❑ Elevated drainfield <br />❑ Baffles <br />C3 Non-domestic waste <br />❑ Baffles ❑ Baffles <br />❑ Non-domestic waste ❑ Electrical issues <br />V0,5 C4 <br />"I <br />❑ Non-domestic waste <br />Other Repairs: <br />City/State/Zip: <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Total Cost of Service: <br />Payment Method: B -C -heck ❑ Cash <br />❑ Credit <br />3 X'5- <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />� <br />_P Septic/holding Tank #1 <br />structurally <br />unsound <br />Gallons: j� <br />❑ Yes 1_3-ido <br />❑ Yes -Cam <br />❑ Yes <br />�� <br />❑ Septic/holding Tank #2 <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />3"Pump Tank <br />Gallons:y�iOL2 <br />❑Yes 0 --No <br />❑ Yes 13'No <br />❑ Yes <br />No <br />low Accessed: BMaintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes EAN-o <br />_E�es ❑ No <br />/j y <br />Did you identl�any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />dtA!'Lad tan Lc —,*-'-1-M__ h... b.... .. . <br />Tank #1 ❑ Yes No <br />....................... <br />Tank #2 ❑ Yes _0> Pump Tank ❑ Yes ErNo <br />System <br />❑ Structural integrity <br />❑ Structural integrity ❑ Structural integrity <br />❑ Mound <br />O Risers leaking <br />❑ Risers leaking ❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />C3 Non-domestic waste <br />❑ Baffles ❑ Baffles <br />❑ Non-domestic waste ❑ Electrical issues <br />❑ Pre�sssure bed <br />1 renches <br />>12 0 <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />uisposal: u Land Application: ❑ Wastewater Treatment Plant <br />)isposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />time: <br />Temperature: <br />pH: <br />>12 ❑ <br />Time: <br />Temperature: <br />pH: <br />>12 0 <br />