HomeMy WebLinkAbout4720 North Arm Drive West - Septic Pumping Report - 2025Jim Eicher
D
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
n ATP 6 -- Q -A-5—
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
0 Nick
Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee: • .-
Name:
Address:�-
Long Pull Fee:
Other Repairs:
City/State/Zip:
1_10(
OAGi/
Total Cost of Sery
Payment Method: ❑ Check ❑ 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
eptic/holding Tank #1
�-
❑Yes 1
❑Yes d"o
��
❑Yes o
Gallons:
eptic/holding Tank #2
❑ Yes 1ao —
El Yes Cho
El Yes o
Gallons:
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
I
ump Tank
ElYes No
❑ Yes C:l. o
Gallons:
❑ Yes No
How Accessed.:2VIntenance Hole
Scum/Sludge M�;�No.
Maintenance H s Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
❑ Yes
es ❑ No
ov7
Did you Identify anperatfonal issues or unsafe conditions while assessing the sewage tanks in this system, I.e.,
L.' f—Lec miccinn hafflac. hrnkan rn r_.2 if so. exolaln in comments below.
Tank #1 ❑ Yes No
Tank #2 ❑ Yes No
Pump Tank ❑ Yes No
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
❑ Ponding/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: ❑ Land Application: dwastewater Treatment Plant
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
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DVANE��
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE L : Y- ZS
Maintenance Inspection Form
MPCA Lic. #L4286
Dv " Maintainer 0 Jim
J�XNick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
iNvnir_F
Pumping Fee:
Name:
Y
..
�al�,� � l �`S ye
Long Pull Fee:
Address:
g �_� l-�kk-�- ��►� Rol
Other Repairs:
City/State/Zip:
C)
Total Cost of Se
k
Payment Method: Check ❑ Cash ❑ Credit
o�
Tank check if resent
( present)
�deslgned
the
Tank leaks above the
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
0low
operating depth
designed operating depth
structurally unsound
eptic/holding Tank #1
Gallons: k 2,5-c
❑ Yes
s ❑ No
❑ Yes E?NU
❑ Yes PrI o
11/4!re: holding Tank #2
ElGallonsns: Yes
❑ No
� Z�
ElYes 2 No
❑ Yes �-_S No
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
El Yes ❑ No
El Yes El No
q�ump Tank
El Yes
�No
El Yes L3 No
❑
Gallons: L
Yes ,C;?No
How Accessed: En Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
El Other (see attached)
CT'Ye/�s El No
1 T1 es ❑ No
�VVL".1'4
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 commenq below.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes ETNo
Pump Tank ❑ Yes No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
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: ET Wastewater Treatment Plant
Disposal Site:
Lime:
Gallons Z(.o.o
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
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Jim Eicher
D
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
nAYU Cn -l 1--7
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer Jim
Nick
Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fe--
Name:
Long Pull FE
Address:.
t
`�
Other Repai
City/State/Zip:
Total Cost of
Payment Method: ❑ Check ❑ Cash ❑ Credit
0L4
Maintenance hole cover is damaged,
Tank (check if present)
ank leaks below the
designed operating depth
Tank leaks above the
designed operating depth
cracked, unsecured, or appears to be
structural) unsound
2-9'eptic/holding Tank #1
Li Yes Cho
❑Yes
No
El Yes n-No
Gallons: �
Septic/holding Tank #2
❑Yes Q No
❑ Yes
/
C No
El Yes �o
Gallons: too
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes ❑ No
Gallons:
Pump Tank
❑ Yes No
❑ Yes
0" No
❑ Yes �No
Gallons: Cep
-low Accessed: Maintenance Hole
Scum/SSl ge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
Q Yes ❑ No
�TYes ❑ No
f�-�°L"
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
nrLa1 f—Lc mlednn haff/oa hrnkon snverc. etr.7 If so. eXolain in comments below.
Tank #1 ❑ Yes ZNo
Tank #2 ❑ Yes 25 No
Pump Tank ❑ Yes ONo
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
ETMound
❑ 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: Er[and Application: ❑ Wastewater Treatment Plant
disposal Site: - (
Lime:
Gallons Z WO
Plowed:
❑ Yes o
rime: 1 (3 o
Temperature: t b.-7
pH:
1 2. $ > 12 Cd'
rime: i Za Z
Temperature: 1'?. [
pH:
t 2 3 > 12 rT
��.-.� cam' ,,�.,`���,� �� • �, ��� '�-�_ ���,�;�'1.1.�
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE � 43 -_)Z57_
Maintenance Inspection Form
MPC Lic. #L4286
Maintainer Jim
0 Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVnIrF
Pumping Fee: 0
Name:
LlmAI
Long Pull Fee:
Address: 7
�`� '"'`
Other Repairs:
City/State/Zip:
C Pa”
Total Cost of Se
Payment Method: ❑ Check ❑ 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
structurally
unsound
eSeptic/holdirm Tank #1
Yes ❑ No
0 Yes �
❑ Yes
No
Gallons.
Septic/holding Tank #2
Gallons: (6�
es ❑ No
❑ Yes .2- �o
❑ Yes
No
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Pump Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
How Accessed: ❑ M/aintteenance Hole
Other (see attached)
Scum/Sludge Measured
❑ Yes No
Maintenance Holes Securely Replaced:
eyes ❑ No
Reason r Pumping:
I
Did you identify y operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
racked tanks, missing baffles, broken s, etc.? If so, explain in comments below.
Tank #1 ❑ Yes ZNo
Tank #2 ❑ Yes n No
Pump Tank ❑ Yes ❑ No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
❑ Mound
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevate ainfield
❑ Baffles
❑ Baffles
❑ Baffles
❑ P ure 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: IZWastewater Treatment Plant V" I.,.r—w V''
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE ( , -i(„ - 2.�
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer Jim
Log WNick
Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
Pumping Fee:
Name: c_'LL � IN V VIVC
-
IEvr1 %
Long Pull Fee:
Address:
r�
Other Repairs:
City/State/Zip:
Total Cost of S�
Payment Method: Check ❑ Cash ❑ Credit
v
70
Tank (check if present)
Tank leaks below the
designed operating depth
Tank leaks above the
designed operating depth
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
structural) unsound
[;, eptic/holding Tank #1
❑Yes
Gallons: t 2
❑'No
El Yes �o
❑Yes C�J'No
Septic/holding Tank #2
Gallons: 1 e J�
/
❑Yes 0 No
❑ Yes R_1q_0
❑ Yes Ef No
❑ Pretreatment Tank
Gallons:
ElYes ElNo
ElYes ❑ No
❑ Yes ❑ No
dPump Tank
Gallons: t iS--)
❑ Yes 2 No
❑ Yes n- No
❑ Yes 2r-'No
How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
❑ Other (see attached) O'Yes ❑ No E Yes ❑ No me;_ 4-
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks In this system, i.e.,
cracked tanks. missino hafflac_ hrnlean rnvarc otr 7 rf cn ovnl�ln in
Tank #1 ❑ Yes o
Tank #2 ❑ Yes No
Pump Tank ❑ Yes ffT No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
ErMound
❑ 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: D<Vastewater Treatment Plant a,,e.4 'v�
Disposal Site:
Lime:
Gallons 2 3 AD
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
RUN`P J, , �'`•'�
Jim Eicher
DVANE*�
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE (9 - 2-5"
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer Jim
1prNick
= Sam
• Phone: 763-497-2764
• Email: duaneseptic9centurylink.net
trvvnir_F
Pumping Fee: 1 _
_
Name:
Long Pull Fee:
lti
Address:
3 ya�o
s-}'
Other Repairs:
\
City/State/Zip:
Total Cost of S
[
Payment Method: El Check ❑ Cash
El Credit
40(A
Tank (check if pre
Tank leaks below the
Tank leaks above the
Maintenance hole cover is damaged,
, crackedunsecured, or appears to be
designed operating depth
designed operating depth
structural)
unsound
Septic/holding Tank #1
Gallons: l Z
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Septic/holding Tank #2
Gallons:
ElYes ElNo
ElYes ElNo
❑ Yes
ElNo
❑ Pretreatment Tank
Gallons:
El ElNo
❑ Yes ❑ No
ElYes
ElNo
❑ Pump Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
How Accessed: ❑ Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
❑ Yes ❑ No
❑ Yes ❑ No
-T-4. Vk !C
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
❑ 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: 1--Land Application: ❑ Wastewater Treatment Plant
Disposal Site:
Lime:
Gallons P 1—sx_9
Plowed:
❑ Yes
2-,M"o
Time:
Temperature: j —1 j
pH:
Z_ 3
> 12
Time: 2 S S
Temperature: j _
pH:
Za 3
> 12