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HomeMy WebLinkAbout05-10-2022 Septic Maintenance FormDVANE*� Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE S'IV• ZZ Maintenance Inspection Form MPCA Lic. # 654 Maintainer Q Jim [] Duane Nick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net IF, Ilk r11/\P9 Pumping Fee: Scum/Sludge Measured Name: Reason For Pumping: ❑ Other (see attached) ❑ Yes T 3-20. "'o 01 -Yc Ilk4v-- ❑ Risers leaking ❑ Risers leaking Long Pull Fee: ❑ Baffles Addrgss: ❑ Baffles ❑ Pressure bed ❑ Non-domestic waste Zo ..� ❑ Electrical issues L ,K , ❑ Non-domestic waste Other Repairs: City/State/Zip: ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No 0- r,D'-d Comments: Total Cost of Service: 7 ��k 1 "� Payment Method: ❑ Check ❑ Cash EJ Credit � , o�. 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 0-9-b'pfic/hoiding Tank #1 Gallons: f �y.p El a—M5, ❑ Yes ❑tidir ❑ Yes PriTo- Septic/holding Tank #2 Gallons: t5-0_'> El 0--N o ❑ Yes Cf No ❑ Yes E) Pretreatment Tank Gallons: ElYes ElNo ❑ Yes 71No ❑ Yes ❑ No Ed"Pump Tank C] Yes Ca�No ❑ Yes Gallons: �2' o ID Yes �,� How Accessed aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) ❑ Yes ❑ No ET Mound Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e., cracked tanks. missinv baffles. broken covers. etc. 7Ifso. exnlaln In cnmmP.ntc nalnw. Tank #1 ❑ Yes No Tank #2 ❑ Yes Oro Pump Tank ❑ Yes No System ❑ Structural integrity ❑ Structural integrity ❑ Structural Integrity ET Mound ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfleld ❑ 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: ©<astewater Treatment Plant Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No Time: Temperature: pH: >12 ❑ Time: Temperature: pH: > 12 ❑ '-�•-•� - ,��� ��►�� � • ✓., Qom' �.-.z C�r'� �`�� i� •^-'l: .✓'-� �`'� .sem. ,..�-� �`'� s�.-