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Jim Eicher D ° Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 Maintenance Inspection Form MPCA Lic. #L4286 Maintainer P Jim Nick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE Pumping Fee: Name:, 1 Z : c� q( Long Pull Fee: Address: 2 0 !�.r Other Repairs: City/State/Zip: Total Cost of rvice: Payment Method: Check ❑ Cash ❑ Credit Maintenance hole cover is damaged, Tank (check if present) Tank leaks below the Tank leaks above the cracked, unsecured, or appears to be designed operating depth designed operating depth structurally unsound optic/holding Tank #1 ❑ Yes No ❑ Yes ❑ x0— ❑ Yes �, Gallons: 13.,ao Septic/holding Tank #2 ❑Yes P�" No ❑Yes C3" No El Yes L7,o Gallons: 13� ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: ClPa�ump Tank ❑Yes ®No El Yes CT No El Yes ��lo Gallons: (oo -low Accessed: EYMaintenance Hole Scum/Sludge Measured Maintenance. Holes Securely Replaced: Reason For Pumping; El Other (see attached) Imes ElNo YYes ❑ No Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., ..__,__ —:__:__ ur__ a..,i.,... cP, 7 rf — a Wn in rnmmpnts below. Tank #1 ❑ Yes 2rfqo Tank #2 ❑ Yes ZI No Pump Tank ❑ Yes Erno System ElStructural integrity ElStructural integrity ElStructural integrity EfMound ❑ 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: niRnnGaL• ❑ Land Aoolication: ZWastewater I reatment runt — • - - )isposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No Temperature: pH: > 12 ❑ ime: Fime: Temperature: pH: > 12 ❑