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HomeMy WebLinkAbout05-03-2023 Septic Maintenance Inspection Jim Eicher Maintenance Inspection Form 4• MPCA Lic. # 654 Maintainer 1 1 Jim ,,,,,irt, , I 1 Duane DVA - lS f 1 Nick Septic Service, LLC 1205 LaBeaux Ave NE • Phone: 763-497-2764 St. Michael, MN 55376 • Email: duaneseptic@centurylink.net DATE INVOICE Pumping Fee: Name: Long Pull Fee: Address: Other Repairs: City/State/Zip: Total Cost of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, Tank(check if present) designed operating depth designed operating depth cracked,unsecured,or appears to be structurally unsound ❑ Septic/holding Tank#1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: ❑ Septic/holding Tank#2 Gallons: ElYes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: ❑ Pump Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: How Accessed:❑Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑Other(see attached) ❑ Yes ❑ No ❑ Yes ❑ No Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., cracked tanks, missing baffles, broken covers, etc.?If so, explain in comments below. Tank#1 ❑ Yes ❑ No Tank#2 ❑ Yes ❑ No Pump Tank ❑ Yes ❑ No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity E Mound ❑ 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 Comments: Disposal: ❑ Land Application: ❑Wastewater Treatment Plant Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No Time: Temperature: pH: >12 ❑ Time: Temperature: pH: >12 ❑ ,k .A �41W46.,r.* C�glLt THANKS! 0 to) ,,e,%:,,0......10 " .— i'°..4",-..1---...6-.W...-411 11i i '4Pr:...- 1