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Jim Eicher D Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 r— "-7_ 1 -z _? L./ Maintenance Inspection Form MPCA Lic. #L4286 Maintainer ❑ Jim Nick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE Pumping Fee: Long Pull Fee: Address: Other Repairs: City/State/Zip: Total Cost of Serv, Payment Method: Ch ck El ❑ Credit Ito 3-0 � Z "? 5� Maintenance hole cover is damaged, Tank (check if present) Tank leaks below the designed operating depth Tank leaks above the designed operating depth cracked, unsecured, or appears to be structurally unsound Er eptic/holding Tank #1 ❑ Yes No ❑ Yes No ❑ Yes No Gallons: _170 Septic/holding Tank #2 ❑ Yes No ❑ Yes Vivo ❑ Yes J2- o Gallons: 1 Z:%-0 ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: ump Tank Gallons: � ❑Yes ;�N:o ❑Yes No El Yes I�No -low Accessed: ffTMaintenance Hole Scum/Stud e Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) 2 es ❑ No ❑ No 1�` •� Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., A,-,J.,... . etr J rf cn -lain in rnmment4 bi<ow. Tank #1 ❑ Yes o Tank #2 ❑ Yes 5KNO Pump Tank ❑ Yes o System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity Mound ❑ Elevated drainfield ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ 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: [3 La Application: u wastewater i reaiment r-iani Disposal Site: Lime: Gallons Z i Plowed: 1-1 Yes No Time: ©' Temperature: 1 �x pH: > 12 Time: (3 ' Temperature: iSr,'j pH: Z,- Z > 12 I •-�.-� Cyr' �-`., `w/ ' • V, � � ,�, ••� _ w`��'� � v��'. ,�-�-•. ,�`'' sue. ,.,�''