4780 North Arm Drive West - Septic Pumping Report

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D�VANE Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 1'1ATL' It_ ) t" - 7_ Maintenance Inspection Form MPCA Lic. #L4286 Maintainer 0 Jim Nick = Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE Pumnino Fee: d , , , , _ Name: Address: t'( -j C) ►;-w wt >r v . City/State/Zip: Payment Method: eck ❑ Ca Credit Maintenance hol over is damaged, Tank (check if present) Tank leaks below the Tank leaks a ve the th cracked, u ured, or appears to be designed operating depth designed operatin structural) unsound ❑'Septic/holding Tank #1 ❑ Yes No ❑ Yes D-tgo ❑ Yes D-<O Gallons:'7,5--^ 09'eptic/holding Tank #2 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: Pretreatment Tank ❑ Yes ET -No❑ Yes Jo ElYes Gallons: -f,� Gump Tank ❑ Yes Q No ❑ Yes El No El Yes B No Gallons: � -low Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: El Other El (see attached) [1 No C Yes ❑ No I v,VLC '- Did you identify any operational issues or unsafe conditions while assessing the sewage tan�kss in this system, i.e., 11-., Apia-_ ;—t—, -. is aFr 7 rf Cn_-Ynlgin in rnmment�elow. Tank #1 ❑ Yes n No Tank #2 ❑ Yes n No Pump Tank ❑ Yes No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity Mound ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield ❑ Baffles ❑ Baffles 10 Baffles ❑ Pressure bed ❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Non -domestic waste ❑ Trenches ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑rYes ❑ No Comments: �o 1 w.�e r„ Disoosal: ❑ Land Application: QWastewater Treatment Plant a --- disposal Site: Lime: Gallons a Z 5',? Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ rime: Temperature: pH: > 12 ❑ �""6 '�.-•.t �..•�- �.�-s� -�---� ,,.�-'�-•. �`'� sue.