HomeMy WebLinkAbout05-19-2022 Septic Maintenance InspectionSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE `S—(q_ Z -L
Maintenance Inspection Form
MPCA Lic. # 654
Maintainer = Jim
Duane
1PN ick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
I kiM.Tre-T=_
Pumping Fee: .{ 350 a�0
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Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Name:
❑ Other (see attached)
❑ Yes Ift<0
Iri�es ❑ No
r kc : A 4
❑ Risers leaking
❑ Risers leaking
Y
❑ Elevated drainfield
❑ Baffles
❑ Baffles
Long Pull Fee:Address..
3:5-, f0
t2 '
❑ Non-domestic waste
❑ Non-domestic waste
❑ Electrical issues
❑ Trenches
a
❑ Ponding/Surfacing
t Z70
❑ Effluent Fllter/screen
❑ Other:
Other Repairs:
Cleaned? ❑ Yes ❑ No
City/State/Zip:
Comments:
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Total Cost of Service:
k
Payment Method:
Check
O Cash
O Credit
IZ-1
z
3'8S
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
eptic/holding Tank #1
Gallons: ,y, ->o
111 Yes
Ci�7o
[I Yes
r�'Ro
❑Yes
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peptic/holding Tank #2
Gallons: (��
❑Yes
f�tdo
I-] Yes
2-9-0
El Yes
❑ No
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
I t Pump Tank
Gallons: (J
❑Yes
110
❑Yes
O'No
CJ Yes
How Accessed: Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
❑ Yes Ift<0
Iri�es ❑ No
r kc : A 4
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.? Ifso, explain in comments below.
Tank #1 ❑ Yes ON o
Tank #2 ❑ Yes No
Pump Tank ❑ Yes ErNo
System
❑ Structural integrity
❑ Structural integrity
❑ Structural Integrity
ound
❑ 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 Fllter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
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Disposal: 3'Cand Application: ❑ Wastewater Treatment Plant
Disposal Site:
Lime: -/
Gallons Z_loo
Plowed:
❑ Yes
❑ No
Time:
Zl 1
Temperature:
pH:
(2-,Y-
> 12 a'
Time:
Z Y
Temperature: I
pH:
t Z. S
> 12 E—
P.
. QW �114F.A091 25U.