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Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />t0 o f <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />lick <br />= Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Name: V <br />Address: <br />Long Pull Fee: <br />City/State/Zip: <br />Other Repairs: <br />U 0 "-o <br />Total Cost of Se <br />I <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />u <br />dw <br />Maintenance hole cover is damaged, <br />Tank (check if <br />eaks below the <br />Tank leaks above the <br />cracked, unsecured, or appears to be <br />operating depth <br />designed operating depth <br />structurally <br />unsound <br />Septic/holding Tank #1 <br />❑ Yes No <br />❑ Yes No <br />❑ Yes <br />2-I10 <br />Gallons: l Z <br />I�tic/holding Tank #2 <br />21"No <br />❑ Yes <br />Gallons: (0.0-0 <br />❑ Yes No <br />❑ Yes <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />ump Tank <br />❑ Yes Zo <br />❑ Yes No <br />❑ Yes <br />1:;�o <br />Gallons: 1 CF-vV <br />1-1 <br />How Accessed: Maintenance Hole <br />Scum/%SI dge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />fl Yes ❑ No <br />es El No <br />�...�— <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />otr 7 Tf cn arnlain in comments below. <br />Tank #1 ❑ Yes 15 No <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <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 />❑ Trenches <br />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: EMastewater Treatment Plant"" ' - __" - <br />Disposal Site: Lime: Gallons 2T-1,53 Plowed: ❑ Yes ❑ No <br />Time: Temperature: pH: > 12 ❑ <br />Time: Temperature: pH: > 12 0 <br />