HomeMy WebLinkAbout05/11/2022 Septic Maintenance FormDUANE�
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE S_ /1,2Z -
Maintenance
f -2Z -
Maintenance Inspection Form
MPCA Lic. # 654
Maintainer Jim
D Duane
A, Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
Pumping Fee: 3 3 b
Na :
Pump Tank ❑ Yes o
System
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❑ Structural integrity
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❑ Risers leaking
❑ Risers leaking
Long Pull Fee:
❑ Baffles
Address:
❑ Baffles
❑ Pressure bed
❑ Non-domestic waste
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❑ Electrical issues
2 S&O
Other Repairs:
❑ Ponding/Surfacing
City/State/Zip:
❑ Effluent Filter/screen
❑ Other:
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Comments:
Total Cost of Service:
k
Payment Method:
❑ Check ❑ Cash
❑ Credit
Tank (check if present)
Tank leaks below the
Tank leaks above the
Maintenance hole cover Is damaged,
designed operating depth
designed operating
depth
cracked, unsecured, or appears to be
unsound
0-8�structural)
c/holding Tank #1
Gallons: tZ51171
❑ Yes 0'1lo
❑ Yes
0TVo
❑ Yes
p'No
❑ Septic/holding Tank #2
Gallons:
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
ump Tank
C1 Yes No
❑ Yes
Gallons:'aQo
o
❑ Yes
❑ No
How Accessed: aintenance Hole Scum/Sludge Measured r!:�����son For Pumping:❑Other (see attached) ❑Yes �t ; h .
Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In thls system, Le.,
cracked tanks. migcInn haffla h_Lea .a erg 7 ra, ,-,.. ,
Tank #1 ❑ Yes o
Tank #2 ❑ Yes O No
Pump Tank ❑ Yes o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
EMound
O 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: O Land Application: ❑ Wastewater Treatment Plant
Disposal Site: Lime:
Gallons Z 2,W
Plowed: ❑ Yes
❑ No
rime: 7
Temperature:
time: / a j'
Temperature: 5"4,
pH: ( 2— S-
> 12 91