HomeMy WebLinkAbout09/16/2021 Septic InspectionSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE .- ? @
Maintenance Inspection Form
MPCA Lic. # 654
Maintainer Jim
D Duane
=' Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
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Pumping Fee:.-
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Name:
❑ Other (see attached)
❑ Yes El No
Yes ❑ No
❑Mound
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
Long Pull Fee: -
❑ Baffles
❑ Baffles
Address:.,_,,
❑ Pressure bed
❑ Non-domestic waste
❑ Non-domestic waste
❑ Electrical issues
❑ Trenches
Other Repairs:
❑ Ponding/Surfacing
City/State/Zip:
❑ Effluent Filter/screen
❑ Other:
01
Cleaned? ❑ Yes ❑ No
Comments:
Total
Total Cost of Service:-�
f lr
Payment Method:
❑ Check ❑ Cash ❑ Credit
Tank leaks below the
Tank leaks above the
Maintenance hole cover is damaged,
Tank (check if present)
designed
operating depth
designed operating depth
cracked, unsecured, or appears to be
structural) unsound
❑ Septic/holding Tank #1
Gallons:
❑ Yes
❑ No
❑ Yes
0- Nd
❑ Yes ❑ No
p'Septic/holding Tank #2
Gallons: ''..._ _
El Yes
El -,No
El Yes
❑ No
El Yes ElNo
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Pump Tank
Gallons:.°
El
❑Y'No
El Yes
❑, No
El Yes No
How Accessed: El Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
❑ Yes El No
Yes ❑ No
❑Mound
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missing baffles, broken covers, etc.? If so, explain in comments below.
Tank #1 ❑ Yes ❑ No
Tank #2 ❑ Yes ❑ 'No
Pump Tank ❑ Yes ❑ No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
❑Mound
❑ 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
)isposal Site: .30
Lime: /
Gallons 2
Plowed:
❑ Yes
❑ No
-ime:
((2-7
Temperature:
pH:
2.3
> 12 Ei-
-ime:
y 2 &10
Temperature:
pH:
)2.3
> 12 [m3-
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