HomeMy WebLinkAbout350 North Arm Lane Maintenance Inspection form Aug 2023Jim Eicher
D
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
_I--1 91
Maintenance Inspection Form
MPCAL4286
Maintainer 0 Jim
[� Duane
Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
UMI L 4 I 1— — ✓
Pumping Fee: j, .,_4�-
Name:
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tJ
Long Pull Fee:
Address:
Other Repairs:
City/State/Zip:
3
V �• / lHlb�
Total Cost of Servic
Payment Method:
❑ Check ❑ Cash
-Credit
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
LI'Septic/holding Tank #1
❑ Yes
No
❑ Yes
❑ Yes
No
Gallons: t ,V
(A Septic/holding Tank #2
0 No
❑ Yes
01110
Gallons: 1 ZS 0
❑ Yes
❑ No
❑ Yes
❑ Pretreatment Tank
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Gallons:
ump Tank
❑ Yes
FA/0
❑ Yes
o
❑ Yes
P'No
Gallons: i 2.S'``�
How Accessed Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
ason For Pumping:
�'%.A-
❑ Other (see attached)
❑ Yes C:Ied
es' ❑ No
`�1'`
Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e.,
.,t_ 7 rF— Whin in __MPnh 0InW_
Tank #1 ❑ Yes No
Tank #2 ❑ Yes DIN o
Pump Tank ❑ Yes No
System
❑ Structural integrity
❑ Structural Integrity
❑ Structural integrity
DIVIound
❑ 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:
niGnnsaL ❑ Land Application: hr Wastewater i reatment riant w-vt 1-w- -
Disposal Site:
Lime:
Gallons Z oe
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
> 12 ❑
Time:
Temperature:
pH:
> 12 0