HomeMy WebLinkAboutSeptic Pumping 8-5-24Jim Eicher
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Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
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Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer ❑ Jim
ick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
I NW1 9 61 t
Pumping Fee:
Name: re
SSA
I'C4w.
Long Pull Fee:
Address- (
,� J
1cd
Other Repairs:
City/State/Zip:
Lon
Total Cost or e:
Payment Method: ❑ Check ❑ Cash
__[ lj Credit
Tank (check i pr ��
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
structurally
unsound
is/holding Tank #1
❑ �
Yes ❑
Yes to
❑ -
El Yes
0 0
Gallons:
Gallon( �,�'�i
eptic/holding Tank #2
ElYes Q No
ElYes MIN o
❑ Yes
�f\ o
Gallons:
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
Gallons:
0,0'ump Tank
ElYes
Gallons: (25�
El Yes L� No
El Yes J;,_Ko
How Accessed:'In Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
ElOther (see attached)
es El9 No
es ❑ No
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
a ii i, rwn, I—Lcn rnv atr 7 rf zn_ axn/Ain in romments below.
Tank #1 ❑ Yes No
Tank #2 ❑ Yes 2No
Pump Tank ❑ Yes PorNo
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
ound
❑ 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: g<gastewater Treatment Plant
Disposal Site:
Lime:
Gallons
Plowed: El
❑ No
Time:
Temperature:
pH:
> 12 ❑
Time:
Temperature:
pH:
> 12 ❑
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