HomeMy WebLinkAbout2760 Deer Run Trl E Maintenance Inspecton Form 2023Jim Eicher
D
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
Maintenance Inspection Form
MP • A Lic. h L4286
Maintainer F Jim
Duane
0 Nick
• Phone: 763-497-2764
• Email: duanesepticCcenturylink.net
INVOICE
Pumping Fee. .75—
Name:
1.
t
Long Pull Fee: tj 0
Address: L
Other Repairs:
(�
City/State/Zip:
C
a
y
Total Cost of Service: ,--
Payment Method: ❑ Check 0 Cash
❑ Credit
Tank (check if present)
Tank leaks below the
Tank leaks above the
Maintenance hole cover is damaged,
cracked , unsecured, or appears to be
designed operating depth
designed operating depth
structural)
unsound
Septic/holding dank #1
❑ Yes
f!� No
❑ Yes
❑ Yes
No
Gallons:
® Septic/holding Tank #2
❑ Yes
2---N'o
❑ Yes d No
❑ Yes
0"N'o
Gallons: 1j
❑ Pretreatment Tank
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes
❑ No
Gallons:
t� mp Tank
/
/
B'No
❑ Yes
%
2 No
Gallons: /�_,
❑ Yes
®' No
❑ Yes
How Accessed: aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For umping:
❑Other (see attached)
❑Yes El❑
No
Did you Idendry any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e.,
,_i,_a #� f, _t«r. h-rfl— h-L-n rnviare -tr 7 rf..cn. axnlain In comments below.
Tank #1 ❑ Yes FeMo
Tank #2 ❑ Yes No
Pump Tank ❑ Yes o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
11 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
❑ Pond!ng/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: ❑ Land Application: XWastewater Treatment Plant
Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No
Time: Temperature: pH: > 12 ❑
Time: Temperature: pH: > 12 ❑
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