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Jim Eicher Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE) Maintenance Inspection Form MPCA Lic. #L4286 Maintainer ❑ Jim Ick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INvn1rF Pumping Fee: Name: Long Pull Fee: - Address: 3 68 Other Repairs: City/State/Zip: E)V'G)AO Total Cost of wr11— Payment Method: ❑ Check ❑ Cash ❑ Credit Tank (check if pr ank leaks below the Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be designed operating depth designed operating depth structurally unsound Septic/holding Tank #1 Gallons: �p9,� ❑ Yes � ❑ Yes ❑" No El Yes Er o Septic/holding Tank #2 El Yes Gallons:1900 121'No ❑ Yes 0 No ❑ Yes No ❑ Pretreatment Tank Gallons: ❑ Yes IDNo ElYes ❑ No ❑ Yes I]No Pump Tank Gallons: C�[fJ ❑ Yes No El Yes No ❑ Yes C3' No I How Accessed: Maintenance Hole Scum/Sludge Measured Maintenanncce Holes Securely Replaced: Reason For Pumping: El Other (see attached) Comes ❑ No Yes ❑ No k '4 Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., racked tanks, missing baffles, broken covers, etc.? If so, explain in comment�,below. Tank #1 ❑ Yes VNo Tank #2 ❑ Yes o Pump Tank ❑ Yes o System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ound ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed ❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches ❑ Non -domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: ❑ Land Application: -R' astewater Treatment Plant H Disposal Site: Lime: Gallons Z 5-D —,I Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 ❑ ,✓�-� �'',�-r sue, .�,-_ ,_r'-'�, ,��/ sue.