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Jim Eicher D Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE I - l l - Z `i Maintenance Inspection Form MPCA Lic. #L4286 Maintainer ❑ Jim *Nick • Phone: 763-z+ui 2 % • Email: duaneseptic@centurylink.net INVOICE Pumping Fee: Name: L 1� Long Pull Fee: Address: �55 Other Repairs: City/State/Zip: d,ror�o Total Cost of Se rvi \ka y Payment Method: ❑ Check [I Cash El Credit u3�.so I ot, Tank leaks below the Tank leaks above the Maintenance hole cover Is damaged, Tank (check if presen )—� designed operating depth designed operating depth cracked, unsecured, or appears to be structural) unsound USeptic/holding Tank #1 ❑ Yes No �,� El Yes P "o ❑ Yes Ba I CO Gallons: z p pKeptic/holding Tank #2 ❑ Yes' ° ❑ Yes ❑Yes ❑'�lo Gallons L V ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ElNo YPump Tank El 1°0 ❑ Yes � ❑ Yes Z?' o Gallons: G2 Y How Accessed: aintenance Hole Did Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) ❑ es ❑ No 1201es ❑ No f %, you identify any operational issues or unsafe coed/bons while assessing the sewage tanks in this system, 1. e., cracked tanks, missing baffles, broken covers, etc.) Ifso, explain in comments below. Tank #1 ❑Yes o Tank #2 El Yes o Pump Tank ❑Yes D 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: El Land Application: ❑Wastewater Treatment Plant Disposal Site: AdjL Lime: Gallons Plowed: El Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 0