HomeMy WebLinkAbout06-27-22 Septic Maintenance InspectionDVANE*�
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE l -2 Z *,Z Z
Maintenance Inspection Form
MPCA Lic. # 654
Maintainer Jim
D Duane
Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.not
I AI\/f1lf%1=
Pumping Fee:.7
Scum/Sludge Measured
Maintenance Holes Securely Replaced:Reason
Name: r�
J� r
Long Pull Fee: � 9D
es El No
❑ Risers leaking
Address: 5 L)p -5-
ou Crv't-ij 9' i
Other Repairs: _
❑ Pressure bed
City/State/Zip:
❑ Trenches
❑ Non-domestic waste
❑ Ponding/Surfacing
❑ Effluent Filter/screen
❑ Other:
Total Cost of Servic
Cleaned? ❑ Yes ❑ No
Payment Method: ❑ Check ❑ Cash ❑ Credit
�./
y�
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
Septic/holdln� Tank #1
Gallons:
1:1 Yes
No
El Yes No
❑ Yes C-, o
Septic/holding Tank #2
Gallons: 1 S—ziG
❑Yes
0- No
❑ Yes E No
❑ Yes No
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
el -Pump Tank `
El Yes
No
❑Yes �f
_No �
El Yes l�No
Gallons: �� U
How Accessed: aMaintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:Reason
For P mping:
C
El Other (see attached)
El Yes CVNo
es El No
❑ Risers leaking
c./
Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e.,
,eracked tanks, missing baffles, broken Vis, etc.? !f so, explain In comments�w.
Tank #1 ❑ Yes FerNo Tank #2 ❑ Yes No
Pump Tank ❑ Yes No
System
❑ Structural Integrity ❑ Structural integrity
❑ Structural Integrity
ound
p Risers leaking ❑ Risers leaking
❑ Risers leaking
❑ Elevated drainfieid
❑ 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: •-Q Land Application: ❑ Wastewater Treatment Plant
Disposal Site: Lime:
Gallons 30 o C
Plowed: ❑ Yes
-D -No
Time: I ., c
Temperature: lv 1
pH: 2 .
> 12--0-,
Time: t., W
Temperature: 6 �
pH: 2--6
> 12
i_