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Jim Eicher <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />n,&TF S-- 30 z <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />0 Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />tNvnicE <br />Pumping Fee: <br />SO <br />"4-D <br />Name 44 4 "SC <br />3 <br />V< <br />Long Pull Fee: <br />Address: IAla 3 s <br />C R U�rp <br />Other Repairs: <br />City/State/Zip: <br />bV,)A-0 <br />Total Cost of Seryie� <br />Payment Method: 2 Check <br />❑ Cash ❑ Credit <br />-7 ► <br />350 <br />nk leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (che ' resent) <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Ea-'Septic/holding Tank #1 <br />El Yes No <br />El Yes ❑�lo <br />❑Yes ❑ No <br />Gallons: � v c� <br />ptic/holding Tank #2 <br />❑ Yes VINo <br />❑ Yes ❑) o <br />❑ Yes ❑ No <br />Gallons: f Lgna <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />❑ Pump Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />How Accessed: El Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Z'4 <br />on For Pumping: <br />t/ ! .t� Other (see attached) ❑Yes CJ No El Yes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />rrarked ranks. missino baffles. broken covers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes ❑ No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non -domestic waste <br />❑ Non -domestic waste <br />❑ Electrical issues <br />iKTrenches <br />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments:-��,o�v( V��.. �,�FS ✓fix 1 o�-e Gam{' <br />0 <br />Disposal: ❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />FJ <br />.s�- <br />