HomeMy WebLinkAbout09-29-2020 Septic Pumping ReportSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 9 ;291 -,:?0
Maintenance Inspection Form
MP Lic. # 654
Maintainer Jim
D Duane
0 Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
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Pumping Fee:
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Name: 1 fP
❑ Other (see attached)
JO
es ❑ No
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❑ Elevated drainfield
❑ Baffles
Long Pull Fee:
❑ Pressure bed
❑ Non-domestic waste
Address:
a 90 Re-,, Tivcz ( E
Other Repairs:
City/State/Zip:
❑ Ponding/Surfacing
Total Cost of Service:
ss __,�
❑ Other:
Payment Method: ❑ Check ❑ Cash ❑ Credit
Tank (check It present)
Tankleaks 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
�eptic/holding Tank #1
Gallons: / Z45 0
❑ Yes
No
❑ Yes P"No
❑ Yes f7 No
eptic/holding Tank #2
Gallons: Z, j—U
❑ Yes
Lel,.to
❑ Yes L�lo
❑ Yes B" No
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
U-.Km'p Tank
_T_'
Gallons: i OLID
❑ Yes
�No
❑ Yes No
❑ Yes No
How Accessed: DVaintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For P mping:
❑ Other (see attached)
❑ Yes [�'No
es ❑ No
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Did you identify ny operational Issues or unsafe condition while assessing the sewage tank in this system, i.e.,
�� racked tanks, misslno baffles, broken ers, etc.? If so, exofain In comment below.
Tank #1 ❑ Yes iff No
Tank #2 ❑ Yes OeNo Pump Tank ❑ Yes No
System
❑ Structural integrity
❑ Structural integrity ❑ Structural integrity
Mound
O 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: ❑ Wastewater Treatment Plant
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
> 12 ❑
Time:
Temperature:
pH:
> 12 ❑
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