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Jim Eicher Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />ick <br />D <br />Sam <br />Septic Service, LLC 1205 LaBeaux Ave NE •Phone: 763-497-2764 <br />St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br />DATE �Y `� zS <br />INVOICE <br />Pun Name: <br />5Cla v1 <br />Lon Address: U <br />Oth City/State/Zip: <br />o -�i 3 3 61ro V�'o <br />T t� �,� Payment Method: ❑ Check ElCash ElCredit <br />ck <br />Maintenance hole cover is damaged, <br />Tank leaks below the Tank leaks above the <br />designed operating depth designed operating depth cracked, unsecured, or appears to be <br />stru turally unsound <br />Septic/holding Tank #1 <br />Gallons: I$_ ❑Yes ❑ No [I Yes ❑ El Yes Colo <br />21'Septic/holding Tank #2 ❑ Yes 01<0 ❑ Yes El Yes .e No <br />Gallons: � ��� <br />❑ Pretreatment Tank <br />Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br />ump Tank <br />Gallons: ❑Yes No El Yes No ❑Yes No <br />How Accessed: El Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />i <br />❑ Other (see attached) Yes ❑ No ©'Yes ❑ No ftlk I ``l°'� <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />,,�r'acked tanks, missinq baffles, broken t6vers, etc.? if so, explain in comments below. <br />Tank #1 ❑ Yes DrNo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes ONo <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ff 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 />❑ Trenches <br />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: )Aland Application: ,'wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons .Z l 6-4 <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />'�.�.t �ir .i'� ��i�•/ •� ���; '_� .•�.t fir �'� �r�/ � <br />,✓�-� ,� .sue. --.�' ,�,�.-'�-�, �`',� �t�,, <br />