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HomeMy WebLinkAboutSchirmers Wastewater Treatment Forms SCHIRMERS WASTEWATER TREATMENT SYSTEMS,INC Steven B Schirmers—951 Katydid Lane NE—St.Michael,MN 55376 schirmerswastewater.com sptestina.wastewaterna,comcast.net Cert.NO.627—(763) 497-3566 —FAX(763)497-5011 State License#395 General Information OWNER: )---Yc��e..- o,--m`‘` t-c"-. PROPERTY LOCATION: ADDRESS: \'ae6YY?c1 c\-. Lr �� C, f oc.OCOUNTY: `rk c,r PHONE: ' S.. .,-‘-na' 05 \L\ EMAIL: Unit Information TANK NO. TYPE OF TANK \( NO.OF MOTORS L SERIAL NO.\A vCC3.\ UV REQUIRED Check List Date of Inspection: ' r) . ' ) Date of Inspection: I `cl '1 -S Item Done Per.Specs Needs Attention Item Done Per.Specs Needs Attention Take Mixed Liquor Sample )( Brown Gray Black Take Mixed Liquor Sample V/Brown Gray Black Check Alarm System ,-Z_ Check Alarm System Turn Off Power — Turn Off Power Rinse Surge Bowl .Y,__ Rinse Surge Bowl Inspect Effluent Quality ' -,(Clear Gray Inspect Effluent Quality Clear Gray Vacuum Weir And Filters c Vacuum Weir And Filters Wash Filters -- Spray off Flushed off Wash Filters -m-; Spray off Flushed off Inspect/Replace Top Gasket ''' Inspect/Replace Top Gasket Vi Inspect/Replace Bottom Inspect/Replace Bottom Inspect Alarm Sensors Inspect Alarm Sensors Inspect Aerator Inspect Aerator Turn On Power Turn On Power "'""� CORRECTION RECOMMENDED CORRECTION RECOMMENDED SETTABLE SOLIDS la % UV SETTABLE SOLIDS % 5 % UV LAB TEST LAB TEST FECAL COLIFORMS FECAL COLIFORMS MONITORED DRAINFIELD MONITORED DRAINFIELD Dry_ Ponding — Depth H2O DryPonding _ Depth H2O 61)L---- -‘22 , -e,,;.- " ---"' el, ... lie SIGNATURE OF SERVICE OR REPAIR MAN SIGNATURE OF SERVICE OR REPAIR MAN AUTHORIZED DISTRIBUOR FOR MULTI-FLO AERATION EQUIPMENT SALES AND SERVICE • _. SCHIRMERS WASTEWATER TREATMENT SYSTEMS,INC. Steven B. Schirmers - 951 Katydid Lane NE • St. Michael, MN 55376 www.mnmultiflo.com - www.multiflo.com Cert.No.627 • (763) 497-3566• FAX (763) 497-5011 State License#395 GENERAL INFORMATION OWNER L.12. v'. RESIDENT ADDRESS I a Q ��U\CL CAAQ '. O f DY\0 COUNTY N 1 U TY ,,u�A. , DATE OF INSPECTION l�--A(-Qc/ PHONE (� ' `tbB , 9&2S 1 - i UNIT INFORMATION TANK NUMBER TYPE OF TANK I Ca 0 0 NO.OF MOTORS - SERIAL NO. u13,I CHECK LIST ITEM DONE PER.SPECS. NEEDS ATTN; TAKE MIXED LIQUOR SAMPLE , !' k q/',f � ). CHECK ALARM SYSTEM S.(-kVA �_IN-VM ��I •?r�, • TURN OFF POWER Ori-N1 O 4 ('�-�J O RINSE SURGE BOWL O O INSPECT EFFLUENT QUALITY O ` ci O VACUUM WEIR AND FILTERS • 5 I O WASH FILTERS O 1fl O� 'O 6 INSPECT/REPLACE TOP GASKET © C INSPECT/REPLACE BOTTOM" Ui,;, INSPECT ALARM SENSORS I`Iv, INSPECT AERATOR �✓ 01 � 001o6 TURN ON POWER O O O O CORRECTIONS RECOMMENDED: REPLACED FILTERS REPLACED EXPANDERS COMMENTS MONITORED DRAINFIELD FOR PERFORMANCE TESTING INFORMATION IN FIELD TESTS TESTS IN LABORATORY PH TEMP B.O.D. - D.O. D.O. C.O.D. • FECAL COLIFORMS SETTABLE SOLIDS % - SUSPENDED SOLIDS /amu -62� LICENSE NUMBER SIGNATURE OF SERVICE OR REPAIRMAN AUTHORIZED DISTRIBUTOR FOR - MULTI-FLO - AERATION EQUIPMENT SALES AND SERVICE • SCHIRMERS WASTEWATER TREATMENT SYSTEMS,INC. Steven B. Schirmers • 951 Katydid Lane NE • St. Michael, MN 55376 www.mnmultiflo.com - www.multiflo.com Cert.No.627 • (763) 497-3566 • FAX (763) 497-5011 State License #395 GENERAL INFORMATION • OWNER-\:>t,v Gve. (7eofqy RESIDENT ADDRESS \2.'5 r�t.,c LC G CI�. 't7e. OrOC^•,p COUNTY I-1 eAsi.1\I(:iP 1 0 DATE OF INSPECTION PHONE c\; ^ coy` ." , UNIT INFORMATION TANK NUMI3ER TYPE OF TANK \ NO.OF MOTORS _ SERIAL NO.U 1")46;>r CHECK LIST ITEM DONE PER.SPECS. NEEDS ATTN: TAKE MIXED LIQUOR SAMPLE 71J,C t4 NC �� 1 •:� 1 CHECK ALARM SYSTEM Vl 2O O OUJO TURN OFF POWER RINSE SURGE BOWL ® 1 INSPECT EFFLUENT QUALITY ")&. !N r ®O O VACUUM WEIR AND FILTERS • A k O WASH FILTERS © INSPECT/REPLACE TOP GASKETT O 1O . /C 1O . C Ir,t CG-) INSPECT/REPLACE BOTTOM" ')C dq,, INSPECT ALARM SENSORSY. ,•;,r OO a-0 O 10 INSPECT AERATOR TURN ON POWER ^� O O O O CORRECTIONS RECOMMENDED: REPLACED FILTERS REPLACED EXPANDERS COMMENTS MONITORED DRAINFIELD FOR PERFORMANCE TESTING INFORMATION IN FIELD TESTS TESTS IN LABORATORY PH TEMP B.O.D. - D.O. D.O. C.O.D. FECAL COLIFORMS SETTABLE SOLIDS % - SUSPENDED SOLIDS S z- ''" LICENSE NUMBER -SIGNATURE OF SERVICE OR REPAIRMAN AUTHORIZED DISTRIBUTOR FOR - MULTI-FLA - AERATION EQUIPMENT SALES AND SERVICE • • Authorized Distributor For Schirmers Wastewater Treatment Systems, Inc. mu/NI 4 Filo 951 Katydid Lane NE • St. IVlichael, MIfT55376=(763) 497-3566 AERATION EQUIPMENT • FAX (763) 497-5011 . .SALES & SERVICE • • • • GENERAL INFORMATION • OWNER N+c..CY 4 9-e-v v:. • ' ',t;c\c�a..••( RESIDENT ADDRESS \ -i5 (4.t,c..\N �ce.e.V.N. _.,mac C7C�tN.0 COUNTY is\ci DATE OF INSPECTION - — 77 PHONE Lr)3- ��t • UNIT INFORMATION ' TANK NO. 1 TYPE OF TANK \ O , NO.OF MOTORS 02 SER.NUMBER tJS7`6 3,• CHECK LIST I:;Ir I tai 0 ,I O na Per. Specs. Need Attn: r Tale Mixed Liquor sample 3151. 1.1[1.. U Oi O Check Alarm System / OO�] `I' O e O Turn Off Power / 4 R Inge Surge Bout Y tl O J O Inspect Effluent Qualityiy: Ci��• ® I I� O Vacuum Weir and Filters 10 O O Nish Filters ©O / 10 Inspect/Replace Top Gasket y Inspect/Replace Bottom r.'"�. '' • Inspect alarm Sensors ® 10 •I'�'' ' '✓ 0 ® 0 • O In3pec;t AeratorTurn Power On --t , O ® 5 O 6 CORRECTIONS RECOMMENDED: REPLACED FILTERS II REPLACE EXPANDERS II . COMMENTS • • • TESTING INFORMATION IN FIELD TESTS PFI • TESTS IN LABORATORY • TEMP D.O. B.O.D. C.O.D._ _ • D.O. SETTLEABLE SOLIDS %S FECAL DED SOLIDS SUSPENDED SOLIDS . cg- • ''''''lz--/.1--. --. • ---- ...... SIGNATURE OF SERVICE OR REPAIRMAN • -..1:- - • LICENSE NUMBER • • • WHITE/Health Dept. YELLOW/01111[1g File • . PINK/Maintenance SCHIRMERS WASTEWATER TREATMENT SYSTE1VIS,INC. Steven B. Schirmers • 951 Katydid Lane NE • St. Michael, MN 55376 wvvw.mnmuitiflo.com - www.multiflo.com CerLNo.627 • (763) 497-3566 • FAX (763) 497-5011 State License # 395 GENERAL INFORMATION OWNER ,5"-c14 '.%"'z7RESIDENT ADDRESS "` Stl° fa' o .1,) COUNTY 448,1`.? .- DATE OF INSPECTION e PHONE (10,,,' 119Z '"",39) UNIT INFORMATION TANK NUMBER / TYPE OF TANK NO O J NO.OF MOTORS SERIAL NO.If1i'D 30) CHECK LIST ITEM DONE PER.SPECS. NEEDS ATTN TAKE MIXED LIQUOR SAMPLE O O O CHECK ALARM SYSTEM ® O JO TURN OFF POWER RINSE SURGE BOWL ® 0 INSPECT EFFLUENT QUALITY _ ® /\ I B O VACUUM WEIR AND FILTERS 2® / 0 \ 10 \ \ 10 WASH FILTERS • © C 0 INSPECT/REPLACE TOP GASKET ?,; 6 INSPECT/REPLACE BOTTOM" O 1O INSPECT ALARM SENSORS „it\ ® INSPECT AERATOR 100 ® s TURN ON POWER O ® ® CORi"ECTIONS RECOMMENDED: REPLACED FILTERS A i r' 4.. REPLACED EXPANDERS COMMENTS ' TESTING INFORMATION IN FIELD TESTS TESTS IN LABORATORY PH TEMP B.O.D. D.O. D.O. C.O.D. •-- FECAL COLIFORMS SETTABLE SOLIDS % SUSPENDED SOLIDS LICENSE NUMBER •E SIGNATURE OF SERVICE OR REPAIRMAN AUTHORIZED DISTRIBUTOR FOR - MUUl TI-FLO - AERATION EQUIPMENT SALES AND SERVICE - r- Authorized Distributor For Schirmers Wastewater Treatment Systems, Inc. ; .;ui ri.El D 951 Katydid Lane NE • St. Michael, MN 55376 • (763)497-3566 'AERATION EQUIPMENT FAX (763) 497-5011 SALES & SERVICE GENERAL INFORMATION OWNER .A.cy w e,�c�c.u� RESIDENT ADDRESS \-4,Gb5 C.(N r ( rf V c �C®c^,C9 COUNTY \AC-nr` DATE OF INSPECTION ce,""' PHONE Lr\r) 9 UNIT INFORMATION TANK NO. TYPEOFTANK \Qs NO.OF MOTORS SER.NUMBER . 4 CHECK LIST 2 I O 2 Item Done Per. Specs. Need Attn: Take Mixed Liquor sample ,7, nUc,ON Com- • 3 0 0 0 Cheek Alarm System O® ® Turn Off Power Rinse Surge Bowl ® A I B O 4 Inspect Effluent Quality j at0,t" (--.4 ® O Vacuum Weir and Filters ✓ © 10 Wash Filters C Inspect/Replace Top Gasket `l Inspect/Replace Bottom " a/ O ® 9 O 10 Inspect alarm Sensors ,, O Inspect Aerator 0 ® O Turn Power On CORRECTIONS RECOMMENDED: REPLACED FILTERS II REPLACE EXPANDERS II • COMMENTS TESTING INFORMATION IN FIELD TESTS TESTS IN LABORATORY PH TEMP_ B.O.D. D.O. D.O. - C.O.O. __ FECAL COLIFORMS SETTLEABLE SOLIDS % SUSPENDED SOLIDS f ; LICENSE NUMBER SIGNATURE OF SERVICE OR REPAIRMAN WHITE/Health Dept. YELLOW/Billing File PINK/Maintenance Authorized Distributor For Schirmers Wastewater Treatment Systems, Inc. 951 Katydid Lane NE • St. Michael,Mid 55376 = 763 497- - �i AL��`�� ( ) 3566 .AERATION EQUIPMENT FAX (763) 497-501'1 SALES & SERVICE GENERAL INFORMATION OWNER N\M y + Jd,, \istme.eq RESIDENT ADDRESS 4ft iS i'14c. t:,.\, %,:)( ` + j l`N COUNTY E ('\f''",) DATE OF INSPECTION (o. PHONE kn^ 6, UNIT INFORMATION TANK NO. TYPEOFTANK \CIO NO.OFMOTORS SER.NUMBER(Ar) , CHECK LIST Item ►• = Per. S. s. Meed Attn: O O Take Mixed Liquor sample 40#4N 2 2 Check Alarm System O O U 3 Turn Off Power O O (--Th O4 Rinse Surge Bowl 4 O I Inspect Effluent Quality cWea4 5 9 Vacuum Weir and FiltersO O ANia 4, eV IO / 117 Wash Filters O C O Inspect/Replace Top Gasket Inspect/Replace Bottom " 7 10 Inspect alarm Sensors ✓ O ® O Inspect Aerator O O O O Turn Power On CORRECTIONS RECOMMENDED: REPLACED FILTERS It REPLACE EXPANDERS It COMMENTS TESTING INFORMATION IN FIELD TESTS TESTS IN LABORATORY PFI TEMP B.O.D. D.O. D.O. C.O.D. FECAL COLIFORMS SETTLEABLE SOLIDS % �' SUSPENDED SOLIDS &2;; LICENSE NUMBER `"J.�. SIGNATURE OF SERVICE OR REPAIRMAN WHITE/Health Dept. YELLOW/Billing File PINK/Maintenance Authorized Distributor For Schirmers Wastewater Treatment Systems, Inc. nottiTl FlVI 951 Katydid Lane KE • St. Michael, MN 55376 • (763) 4974566 .AERATION EQUIPMENT FAX (763) 497-5011 .SALES & SERVICE GENERAL INFORMATION OWNER hii +ol 4' <Ae+0o,. IAN CN ,.V,,! RESIDENT ADDRESS a 1 Tisco.[ (.e'tX. \0/, Com)rC+r,O COUNTY Vi ttm, DATE OF INSPECTION I .• z HONE S ��, `-14 k ‘ UNIT INFORMATION . TANK NO. \ TYPEOFTANK ‘C)4'' ' NO.OF MOTORS k SER.NUMBER Urni . CHECK LIST O ® O Item Done Per. Specs. Need Attni Trke Mixed Liquor sample J 1'iC'-1r' ®®O O ® Check Alarm System ® ® ® Turn Off Power Rinse Surge Bowl O A ( B O Inspect Effluent Quality 0 euL! 5 5 Vacuum Weir and Filters 10 /O\ 1l) O 10 Nash Filters O C Inspect/Replace Top Gasket Inspect/Replace Bottom " / O ✓ ® ® 10 ® Inspect alarm Sensors O Inspect Aerator O ® O Turn Power On CORRECTIONS RECOMMENDED: REPLACED FILTERS# REPLACE EXPANDERS#. COMMENTS TESTING INFORMATION IN FIELD TESTS TESTS IN LABORATORY • PH TEMP_ B.O.D. D.O. 0.0. C.O.D. __ FECAL COLIFORMS SETTLEABLE SOLIDS % 3------ SUSPENDED SOLIDS 4::4:-;/;?, el, 1 - LICENSE NUMBER SIGNATURE OF SERVICE OR REPAIRMAN WHITE/Health Dept. YELLOW/Billing Fite PINK/Maintenance • Authorized Distributor For Schirmers Wastewater Treatment Systems, Inc. itimiLTI4FjJJ 951 Katydid Lane NE 'St. .iliahaei, MN 55376 • a-63)-40745a ;AERATION EQUIPMENT FAX (763) 497-5011 :SALES & SERVICE GENERAL INFORMATION - OWNER y J ireV.t Q-r`ne-c ,\/ RESIDENT '1 ADDRESS \ �'�r\C-� 6.4'"'x. "0(' .k fioc`` COUNTY �It''R DATE OF INSPECTION '‘i. ,--T—•C4g PHONE 'I�3 —13q 1 UNIT INFORMATION TANK NO. \ TYPEOFTANK. \00r2NO.OFMOTORS \ SER.NUMBER U9/3Y, I CHECK LIST ® . • ® Item Done Per, Specs. Need Attnt 2 O Take Mixed Liquor sample 4/ (,� jA • 06-1�O O O Check Alarm System 4,— O J O Turn Off Power 4 Rinse Surge Bowl 4 O A I B Inspect Effluent Quality �le.ce.r 5 O O Vacuum Weir and Filters 10 -" 10 Wash Filters am-'• O v Inspect/Replace Top Gasket t✓,Z O Inspect/Replace Bottom " ►✓ ®O ® ®O0OInspect alarm Sensors O ®Inspect Aerator Turn Power On —4 CORRECTIONS RECOMMENDED: REPLACED FILTERS tt REPLACE EXPANDERS It • COMMENTS • • TESTING INFORMATION • IN FIELD TESTS TESTS IN LABORATORY • PH TEMP_ B.O.D. D.O. D.O. • C.O.D. FECAL COLIFORMS SETTLEABLE SOLIDS % 15 SUSPENDED SOLIDS c, -- a ' fir- LICENSE NUMBER SIGNATURE OF.SERVICE OR REPAIRMAN • WHITE/Health Dept. YELLOW/Billing Flle PINK/Maintenance , ,,. Authorized Distributor For Schirmers Wastewater Treatment . Systems, Inc. ; L TI4FJ[IJ 951 KatydidCaeNE . 1.-St. MN-65376 •.(' S49: �6. • :AERAtoN EQUIPMENT FAX (763) 497_ :$ALES & SERVICE .GENERAL INFORMATION • OWNER 1�°.1 I + .4-u2 RESIDENT ADDRESS 1"1�tS` r"(c.(NG\i` Cr�� tS,f.. E.)r_n n o COUNTY Z�1 PHONE ' � — a(� 'meq- " .''-.. ...-q'---::-:---3-11‘ ; DATE OF INSPECTION UNIT INFORMATION • aSER.NUMBER��� :•7',, ' TANKNO. TYPEOFTANK NO.OFMOTORS • CHECK LIST • 0 Item Per. Specs. Need Attnt 3 OO . O 0 3 Take nixed Liquor sample II[1)%4N () ®O t;7 k Alarm System co Turn orr Power t I O Rinse Surge Bowl •/ O A O B O Inspect Effluent Quality krI � "---- © 10 1Q Vacuum heir end Filters • C Wash Filters . Inspect/Replace Top Gasket . / O ® Inspect/Replace Bottom 14 O© ® O O Inspect alarm Sensors Inspect Aerator . OO • Turn Power On CORRECTIONS RECOMMENDED: . REPLACED FILTERS 1; REPLACE EXPANDERS I: COMMENTS • ' • TESTING INFORMATION IN FIELD TESTS TESTS IN LABORATORY . . PH TEMP._ B.O.D. D.O. D.O. . FECAL COLIFORMS C.O.D. _ SUSPENDED SOLIDS SETTLEABLE SOLIDS 96 .c ,, ' i_._ LICENSE NUMBERy�1� SIGNATURE OF SERVICE OR REPAIRMAN • • ' WHiTE/Health Dept. YELLOW/BIIIIng Fite ` PINK/Maintenance Schirmers Wastewater Treatment'Systems, Inc. I •:.� L714F10 951 Katydid Lane' ' Sf: cfae&, • N.. T •.(T5 ).40.748-66. • ;AERATION EQUIPMENT FAX (763) 497-5011 :$ALES & SERVICE • •GENERAL INFORMATION OWNER 4 `#` 0 X11:4 0; 'l` RESIDENT . ADDRESS I ;, 0 s- c-r- `u-' 61-(:'640.- tom'' 6-'06,1.1t1 O JJNTY 14-V' •••1 f.•i. DATE OF INSPECTION II -••)q--017} PHONE Lr73'''' ) UNIT INFORMATION • TANK NO. 1 TYPEOFTANK. I DO O NO.OF MOTORS SER,NUMBER LI Wit?,' • CHECK LIST 0 I pone Per. Soecs. Need Attnt 2 2 Take Mixed Liquor sample �t v4�4 3 U O (�O O �/ Cheek Alarm System _._._._ �•--- v ,4 Turn Orf Power _ ®O I O Rinse Surgo Bowl A O Inspect Effluent Quality �ii ''A - __ e 10 /O\ 10 Vacuum Weir and Filters © C Wash Filters �+ Inspect/Replace Top Gasket / O O O ® ® © s Inspoct/Rnpisce Bottom " _..�.-- IInspect Aerator • O ® ® Turn Power On -.14 CORRECTIONS RECOMMENDED: REPLACED FILTERS It • REPLACE EXPANDERS It COMMENTS TESTING INFORMATION IN FIELD TESTS TESTS INLABORATORY • • PH TEMP_ B.0.0. D.O. D.O. • C.O.D. _ ,r FECAL COLIFORMS SETTLEABLE SOLIDS % i s SUSPENDED SOUDS • .. .-71--- , `.,.?„..,,‘-r ,�,, r cam' • LICENSE NUMBER ` . SIGNATURE OF SERVICE OR REPAIRMAN WHITE/Health Dept. YELLOW/81111np File • PINK/MaIntenance