Laserfiche WebLink
Jim Eicher <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 7_ 'so _ 7- V <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />Nick <br />® Phone: 763-497-2764 <br />® Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />5V <br />Nameat I I !c" 5 <br />t 2 <br />Long Pull Fee: <br />Address: 3 3 (- 0 <br />r <br />Other Repairs: <br />City/State/Zip: <br />ro <br />Total Cost of ervice: <br />Payment Method: El Check El Cash El Credit <br />Tank (check if =present)esigned <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />operating depth <br />designed operating depth <br />structural) unsound <br />peptic/holding Tank #1 <br />No <br />Yes No <br />Gallons: 15W <br />❑ Yes E�_Pd'6'— <br />❑ Yes <br />❑ <br />Septic/holding Tank #2 <br />❑Yes No <br />(� <br />❑Yes No <br />El Yes rl < <br />Gallons: <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />ump Tank <br />ElYes 0 No <br />ElYes e<o <br />❑ Yes 0 <br />Gallons: <br />How Accessed: &Maintenance Hole <br />Scum/Slu Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />C'Yes ❑ No <br />es ❑ No�ont�-vv4- <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks, missing baffles, broken 4overs, etc.? if so, explain in comment�w. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes No <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: ❑ Land Application: 1L1�wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons 2 <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Prof <br />.t ir � I I I I �`'� .sue. ,✓•-'�-� �`'� s�- <br />