Laserfiche WebLink
Jim Eicher <br /> Maintenance Inspection Form <br /> MPCA Lic. #L4286 <br /> -Je�V Maintainer ❑ Jim <br /> 1MAWS Nick <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> DATE 41-- Z Y- 2 ./ INVOICE <br /> Pumping Fee: Lk, Name: �1C Cry y L S <br /> Long Pull Fee: 1, Address: Q <br /> Other Repairs: City/State/Zip: <br /> Total Cost of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit <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) designed operating depth designed operating depth <br /> structurally unsound <br /> 0 Sepfic/holding Tank#1 ❑ Yes No ❑ Yes Erri6- ❑ Yes No <br /> Gallons:on� I Z_ <br /> IO <br /> l�Septic/holding Tank#2 <br /> ❑ Yes [rNo ❑ Yes No ❑ Yes <br /> Gallons: ( Z 5 9 <br /> ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Gallons: <br /> 23'Pll/ump Tank ❑ Yes 121"No ❑ Yes ❑ No ❑ Yes elrlo- <br /> Gallons: <br /> How Accessed:Er intenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason F r Pumping: <br /> ❑Other(see attached) C;3'S'es ❑ No es ❑ No 1'11A..\VT t.•.5 .:_ti'4.fr2 <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 ❑ (T Yes No Tank#2 El Yes C'No Pump Tank ❑ Yes eJ No Systems ; <br /> ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity u Mouno <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles 0 Pressure bed <br /> ❑ Non-domestic waste ❑ Non-domestic waste 0 Electrical issues 0 Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> O Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes 0 No <br /> Comments: <br /> Disposal: ❑ Land Application: I;lWastewater Treatment Plant (,.ir--fri/(41-"i.r <br /> Disposal Site: Lime: Gallons 7--5'-' Plowed: ❑ Yes ❑ No <br /> Time: Temperature: pH: >12 ❑ <br /> Time: Temperature: pH: >12 0 <br /> .► C� <br /> .� THANKS! - (g �� / . 46...° <br />