Laserfiche WebLink
Jim Eicher <br />D <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE I- i_ -2e - <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />' itivnir_t= <br />Pumping Fee: <br />Scum/Sludge Measured <br />Name: <br />Reason For Pumping: <br />El Other (see attached) <br />E] Yes i Nl <br />❑'Yes ❑ No <br />MCL <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />Long Pull Fee: <br />❑ Baffles <br />❑ Baffles <br />Address: <br />❑ Pressure bed <br />❑ Non-domestic waste <br />0.0-C, <br />❑ Electrical issues <br />❑ Trenches <br />a��(7 <br />�� � ilk <br />❑ Non-domestic waste <br />Other Repairs: <br />City/State/Zip: <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Total Cost of Service: <br />•—r ( �i k <br />Payment Method: <br />2 Check L1 Cash <br />❑ Credit <br />l'^ <br />X31370 <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />designed <br />operating depth <br />designed operating depth <br />structural) <br />unsound <br />— <br />� <br />9-Septic/holding Tank #1 <br />Gallons: Lr <br />❑ Yes <br />❑—P <br />❑ Yes <br />❑Yes <br />[1V0 <br />e: holding Tank #2 <br />Gallons: <br />El Yes <br />Q No <br />El Yes <br />11:1,_<01:1,_<0 <br />13 Yes <br />� <br />,� <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Pump Tank <br />❑ Yes <br />ZNo <br />❑ Yes <br />E2 No <br />❑ Yes <br />C3�o <br />Gallons: jxvco <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />E] Yes i Nl <br />❑'Yes ❑ No <br />MCL <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />Wicked tanks, missing bafFles, broken cyvers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes ONo <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes 21To <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: E't'aind Application: ❑ Wastewater Treatment Plant <br />Disposal Site: L( <br />Lime: <br />Gallons <br />Plowed: ❑ Yes <br />e -No <br />Time: <br />j p Z ? <br />Temperature: <br />(� <br />pH: f L .1 <br />> 12 R-" <br />Time: <br />t 051 <br />Temperature: <br />pH: Z-1 <br />> 12 E;-' <br />