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HomeMy WebLinkAbout05-06-2022 Septic Maintenance FormSeptic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 nATF L5-6-22— Maintenance Inspection Form MPGA Lic, # 654 Maintainer u� J/im D Duane D Nick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net Pumping Fee: JSiJ Scum/Sludge Measured Maintenance Holes Securely Replaced: Name: k IIVvultit ❑Yes 0-M-0, ales ❑ Nc 0—Mound Gj.e��r1�v, t� Long Pull Fee: ❑ Elevated drainfield ❑ Baffles Address: ❑ Baffles ❑ Pressure bed ❑ Non-dome$tic waste ❑ Non-domestic waste 7) L Other Repairs: . City/State/Zip: ❑ Ponding/Surfacing ❑ Effluent Fllter/screen 0 rv.rt o Total Cost of Service: �, ) Comments: Payment Method: ❑ Check ❑ Cash ❑ Credit Tank (check if present) Tank leaks below the Tank leaks above the Maintenance hole cover Is damaged, designed operating depth designed operating depth cracked, unsecured, or appears to be structural) unsound Septic/holdin�nk #1 Gallons: 1 ❑ Yes Flo ❑ Yes EriTo ❑ Yes ' Septic/holding Tank #2 Gallons: 1 z) -v ❑Yes ❑Yes ( ❑ Yes DY<O ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No amp Tank ❑ Yes Gall� Zj� Gall No ❑ Yes No E3ons: Yes How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For umping: El Other (see attached) ❑Yes 0-M-0, ales ❑ Nc 0—Mound Did you fdentlfy�a"operational Issues or unsafe conditions while assess/ng the sewage tanks in this system, i.e., �CP3CK'd tanks. mlccinn haffia hmLnn Tank #1 ❑ Yes No Tank #2 ❑ Yes No --I--�---....- --......_........ Pump Tank ❑ Yes o ... System ❑ Structural integrity ❑ Structural integrity ❑ Structural Integrity 0—Mound 0 Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed ❑ Non-dome$tic waste ❑ Non-domestic waste ❑ Electrical issues O Trenches ❑ Non-domestic waste ❑ Ponding/Surfacing ❑ Effluent Fllter/screen ❑ Other: Cleaned? ElYes ❑ No Comments: Disposal: .„,-'Land Application: ❑ Wastewater Treatment Plant Disposal Site: 3 f7a Lime: Gallons ,1� y Plowed: ❑ Yes —ff-No Time: 1 '30 Temperature: s ; H: p 7 , > 12--a- Time: Time: 2 Temperature: S y pH: = .? > 12 "D—