HomeMy WebLinkAbout07/18/2022 Septic Maintenance InspectionJim Eicher
I
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
Maintenance Inspection Form
IMP A Lic. # 654
Maintainer Jim
Duane
D Nick
• Phone: 763-497-2764
• Email: duaneseptic@century]ink.net
INVOICE
uta � � � - • -
Pumping Feer
❑ Risers leaking
Name: C 6,
5 F�
❑ Baffles
❑ Baffles
❑ Baffles
❑ Pressure bed
Long Pull Fee:
❑ Non-domestic waste
Address: 2-1
Other Repairs:cc, �� Z�—
City/State/Zip:
❑ Non-domestic waste
❑ Ponding/Surfacing
r� itib
❑ Effluent Filter/screen
Total Cost of Service:
Payment Method: ❑Check
❑Cash ❑Credit
Y
5—
Maintenance hole cover is damaged,
Tank (check if present)
Tank leaks below the
designed operating depth
Tank leaks above the
designed operating depth
cracked, unsecured, or appears to be
structural) unsound
Septic/holding Tank #1
❑ Yes o r
❑ Yes B-190-
❑ Yes e'IV'o
Gallons: 1,15--O
eptic/holding Tank #2
❑ Yes C-1'IQo
❑ Yes 'Euro
❑ Yes D -M-0
Gallons:
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
ump Tank
❑Yes CYNo
❑Yes C3"IQo
=�j
E03 Yes
Gallons: ja Sb
How Accessed: ElVaintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pu ping:
❑ Other (see attached) ❑ Yes ❑.Alves es ❑ No C e
Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system, I.e.,
cr ed tanks, missing baffles, broken covers, etc.? Ifso, explain in comments below.
Tank #1 ❑ Yes o Tank #2 ❑ Yes EkNo Pump Tank ❑ Yes o System
1i t if ❑ Structural integrity ❑ Structural integrity OR<und
❑ Structura n eg. y
O 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
Disposal: —'Land Application: ❑ Wastewater Treatment Plant
Disposal Site: y Lime: Gallons 2 6 Plowed: ❑ Yes •0 -No
Time: 'f,' =
t �,� Temperature: j ti pH: i 2 . <; > 12--0
Time: ' . 1 Temperature: - l 6, pH: t �. • ` > 12--I!
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