Laserfiche WebLink
Jim Eicher <br />Maintenance Inspection Form <br />r <br />DVANE� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE' "7 - 2r <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />'Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping F <br />Name:�s5RA <br />Long Pull I <br />Address: <br />Ll 2-co <br />(2j <br />Other Rep <br />City/State/Zip: <br />Total Cost <br />� <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />leaks below the <br />Tank <br />d operating depth <br />designed operating depth <br />structural) <br />unsound <br />eptic/holding Tank #1 <br />❑ Yes No <br />❑ Yes C-1q; <br />❑ Yes <br />No <br />Gallons: <br />Septic/holding Tank #2 <br />El Yes 16 No <br />El Yes 171 No <br />El Yes <br />❑ No <br />Gallons: t00,0 <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />21"Pump Tank <br />❑Yes <br />Colo <br />Gallons: 3 <br />El Yes �' No <br />❑Yes No <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />12 es ❑ No <br />2- es ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />tracked tanks, missing baffles, broken covers, etc.? If so, explain in commentsbelow. <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: FrIand Application: ❑ Wastewater Treatment Plant <br />Disposal Site: rye Z <br />Lime: <br />Gallons 2- t--) <br />Plowed: ❑ Yes <br />Time: <br />' t q <br />Temperature: -?_ t <br />pH: t Z-'L <br />> 12 <br />Time: <br />q ql <br />Temperature: 7 0 - -7 <br />pH: t 2- Z <br />> 12 E�' <br />