HomeMy WebLinkAbout12-14-23 Septic Pumping ReportJim Eicher
in
D a
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
r � 2
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer ❑ Jim
dick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
U F11 L l "- a - i
Pumping Fee:
Tank #2 ❑ Yes No
Pump Tank ❑ Yes o System
Name -
❑ Structural integrity
❑ Structural integrity Lei Mound
❑ Elevated drainfield
❑ Risers leaking
c9�
❑ Risers leaking
❑ Pressure bed
❑ Baffles
❑ Non-domestic waste
❑ Baffles
❑ Non-domestic waste
❑ Baffles
❑ Electrical issues ❑ Trenches
Long Pull Fee:
❑ Non-domestic waste ❑ Ponding/Surfacing
Address:
1�
� O ✓1
Other Repairs:
Cleaned? ❑ Yes ❑ No
City/State/Zip:
Total Cost of Service:
Payment Method: El Check El Cash
El Credit
`�
T
�� `{S- C�
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-'-
No
El Yes Jo
❑Yes
No
Gallons:
Gallons: � Z�cs
P-S<`eptic/holding Tank #2
❑ Yes
No
❑ Yes Id' No
❑ Yes
Gallons: t Zj0
❑ Pretreatment Tank
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes
❑ No
Gallons:
®'Pump Tank
❑ Yes
❑'No
❑ Yes
❑ Yes
❑to
Gallons: t ZS"b
How Accessed: aintenance Hole Scum/Sludge Measured Maintena/nce� Holes Securely Replaced: Reason For Pumping:
ElOther (see attached) l�Yes ❑ No �J Yes ❑ No v'K
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks /n this system, i.e.,
ti_.. i.,... ,. nf. 7 rf en avn/ain in rnmment5 below.
Tank #1 ❑ Yes No
Tank #2 ❑ Yes No
Pump Tank ❑ Yes o System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity Lei Mound
❑ Elevated drainfield
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Pressure bed
❑ Baffles
❑ Non-domestic waste
❑ Baffles
❑ Non-domestic waste
❑ Baffles
❑ Electrical issues ❑ Trenches
❑ Non-domestic waste ❑ Ponding/Surfacing
❑ Effluent Filter/screen ❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: ❑ Land Application: ,,rwastewater Treatment Plant
Disposal Site: Lime: Gallons Z.1_0 0 Plowed: ❑ Yes ❑ No
Time: Temperature: pH: >12 ❑
Time: Temperature: pH: >12 0