HomeMy WebLinkAbout08-30-22 Septic Maintenance InspectionJim Eicher
D °
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
Maintenance Inspection Form
MPCA Lic. # 654
Maintainer O Jim
D Duane
Nick
IT
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee:
Pump Tank ❑ Yes No
Name;
❑ Structural integrity ❑ Structural integrity
Long Pull Fee:
7i� c9 -O
Mound
❑ Elevated drainfield
O Risers leaking ❑ Risers leaking
Address:
3q 6-s-
6 -le- 4et-
a A le rA
Other Repairs:
❑ Pressure bed
❑ Non-domestic waste ❑ Non-domestic waste
City/State/Zip:�
A,
❑ Non-domestic waste
Total Cost of Service:i
��
Payment Method:
❑ Check
❑ Cash ❑ Credit
.0-0
O tit
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
structurally unsound
Septic/holding Tank #1
E3Yes
No
❑ Yes
0-90
❑ Yes R_1T0
Gallons: j ra.¢-o
[; S ptic/holding Tank #2❑Yes
❑Yes
p' leo
❑ Yes ❑
Gallons: jv CO
❑ Pretreatment Tank
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
Gallo s:
Pump Tank
❑ Yes
Q No
❑ Yes
0--N a
❑ Yes
11-00
Gallons: �
-iow Accessed: ElMaintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
❑ Other (see attached) 1 ❑ Yes ❑ No ❑ Yes ❑ No
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, I.e.,
— i ror— i.i. In rnm monfc hpinw.
Tank #1 ❑Yes o Tank #2 ❑Yes No
Pump Tank ❑ Yes No
System
❑ Structural integrity ❑ Structural integrity
❑ Structural integrity
Mound
❑ Elevated drainfield
O Risers leaking ❑ Risers leaking
❑ Risers leaking
Time: t63
❑ 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:
Disoosal: E -Land Application: ❑ Wastewater I reatment rlani
Disposal Site: I Urne:
Gallons 7 100
Plowed: ❑ Yes
-e No
Time:
Temperature: (oS
pH: jL, 3
> 12
Time: t63
Temperature: fF, 6
pH: 17 -3
> 12
,..�-�`--•. ,�`'� sem- ,_/.` �'