Laserfiche WebLink
Jim Eicher Maintenance Inspection Form <br /> s^ MPCA Lic. # 654 <br /> �j,A Maintainer I I Jim <br /> -...„ I 1 D u ane <br /> W10110111„, <br /> DUANIS �. <br /> * ;-Nick <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> : INVOICE <br /> DATE �. '1 il () �- <br /> Pumping Fee: Name: , <br /> Per 2...,3 ti.. . fi 'b.;.,.' vAl,.:a{""5�•:•'le; I. .-i, 3 <br /> Long Pull Fee: <br /> } Address: <br /> 7g f <br /> Other Repairs: City/State/Zip: <br /> Total Cost of Service .. .. Payment Method: CI- heck ❑ Cash ❑ Credit <br /> C <br /> Maintenance hole cover is damaged, <br /> - Tank leaks below the Tank leaks above the cracked,unsecured,or appears to be <br /> Tank(check if present)'V designed operating depth designed operating depth <br /> structurally unsound <br /> C Septiclhalding Tank#1 ❑ Yes <� No ❑ Yes Et Na ❑ Yes ❑ No <br /> Gallons. .. x -, ? _ <br /> ❑.Septic/holding Tank#2 `_ <br /> Gallons: ,� ❑ Yes [ `No ❑ Yes 0,-NO 0 Yes C tlo <br /> ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Gallons: <br /> ❑,Pump Tank " <br /> Gallons: , c " <br /> ❑ Yes ❑ 10 ❑ Yes [ iVo El Yes ❑ .{ <br /> How Accessed:EMaintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> ❑Other(see attached) 0 Yes ❑ No L Yes ❑ No /1%--1 em:,;;, _. <br /> I <br /> Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br /> cracked tanks,missing baffles, broken covers, etc.?If so, explain in comments below. <br /> Tank#1 ❑ Yes 0 No Tank#2 ❑ Yes 2t to Pump Tank ❑ Yes 2116 System <br /> ❑ Structural integrity ❑ Structural integrity 0 Structural integrity Efr <br /> ❑ Risers leaking 0 Risers leaking 0 Risers leaking 0 Elevated drainfield <br /> ❑ Baffles 0 Baffles ❑ Baffles ❑ Pressure bed <br /> ❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑Trenches <br /> 0 Non-domestic waste 0 Ponding/Surfacing <br /> ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes 0 No <br /> Comments: <br /> Disposal: ❑ Land Application: ❑Wastewater Treatment Plant <br /> Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br /> Time: Temperature: pH: >12 D <br /> Time: Temperature: pH: >12 ❑ <br /> �, A y % yTHANKSi * J <br /> :4'M go , ...dr, ....,c� <br /> ........ 10411 +.._.�� �/' .e--r' err,.•-.. <br />