HomeMy WebLinkAbout09-30-2021 Septic Pumping reportNOR
DUANE�
Septic Service, LLC
1205 LaSeaux Ave NE
St. Michael, MN 55376
DATE 0_30-7-(
Maintenance Inspection Form
MPCA Lic. # 654
Maintainer C�l Jim
C�] Duane
*Dick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee: 3�
Tank #2 ❑ Yes ONo
Na e:
System
❑ Structural integrity
❑ Structural integrity
Long Pull Fee:
❑ Mound
Address:
Cr + �
A
❑ Elevated drainfleld
❑ Baffles
1531156ffles
15-70
❑ �PPcs sure bed
vt
,.
Other Repairs:t� �
� j$ � n t -4,
�
City/State/Zip:
(j4t% p.4 6,1+
171 Non-domestic waste
❑ Ponding/Surfacing
Total Cost of Service:
❑ Effluent Filtertscreen
Payment Method:
❑ Check ❑ Cash
❑ Credit
Cleaned? ❑ Yes ❑ No
Comments: � eelN0Cov¢ r f �� �l i ) 4 ti.4 k • W
Tank (check if present)
Tank leaks below the
Tank leaks above the
Maintenance hole cover Is damaged,
cracked, unsecured, or appears to be
designed operating depth
designed operating
depth
structural) unsound
t llonsc/hol Tank #1
E] Yes �
❑ Yes
t�
Gallons: app
p4
es
epticlholding Tank #2
Gallons: 1
ED Yes L
❑ Yes
�
El
_L_1�0
El Pretreatment Tank
Gallons:
❑ Yes ❑ No
ElYes
ElNo
EIYes
17No
❑ Pump Tank
Gallons;
O Yes C1No
C3 Yes
F-1No
LJ Yes
CDNo
How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
❑ Other (see attached) ❑ Yes Fr -No DI?es ❑ No
Did you identify any operational issues or unsafe conditions while assessing the sewage ranks in this system, i.e.,
cracked tanks, missing baffles, broken Fevers, etc.? It so, explain in comments below.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes ONo
Pump Tank ❑ Yes ❑ No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
❑ Mound
❑ Risers leaking
❑ R'Pers leaking
❑ Risers leaking
❑ Elevated drainfleld
❑ Baffles
1531156ffles
❑ Baffles
❑ �PPcs sure bed
❑ Non-domestic waste
❑ Non-domestic waste
❑ Electrical issues
C trenches
(j4t% p.4 6,1+
171 Non-domestic waste
❑ Ponding/Surfacing
tuP
❑ Effluent Filtertscreen
❑ Other:
$k�<<
Cleaned? ❑ Yes ❑ No
Comments: � eelN0Cov¢ r f �� �l i ) 4 ti.4 k • W
v
Disposal: ❑Land Application: ❑Wastewater Treatment Plant I
Disposal Site:
Lime: Gallons
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
>12 ❑
Time:
Temperature:
pH:
> 12 ❑
We') 11neg