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Jim Eicher na D Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 nAT= t—.:5-- 2 V Maintenance Inspection Form MPCA Lic. #L4286 Maintainer ❑ Jim ick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net I NW1 9 61 t Pumping Fee: Name: re SSA I'C4w. Long Pull Fee: Address- ( ,� J 1cd Other Repairs: City/State/Zip: Lon Total Cost or e: Payment Method: ❑ Check ❑ Cash __[ lj Credit Tank (check i pr �� Tank 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 is/holding Tank #1 ❑ � Yes ❑ Yes to ❑ - El Yes 0 0 Gallons: Gallon( �,�'�i eptic/holding Tank #2 ElYes Q No ElYes MIN o ❑ Yes �f\ o Gallons: ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: 0,0'ump Tank ElYes Gallons: (25� El Yes L� No El Yes J;,_Ko How Accessed:'In Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ElOther (see attached) es El9 No es ❑ No Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., a ii i, rwn, I—Lcn rnv atr 7 rf zn_ axn/Ain in romments below. Tank #1 ❑ Yes No Tank #2 ❑ Yes 2No Pump Tank ❑ Yes PorNo 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 ❑ Pond! ng/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: ❑ Land Application: g<gastewater Treatment Plant Disposal Site: Lime: Gallons Plowed: El ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 ❑ .mac �+r ./� ~` t`►i�•/ �., .mot C 6zmo, �/I N