HomeMy WebLinkAbout08-12-2022 Septic Maintenance InspectionSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
nert` g- 12-2 _Z
Maintenance Inspection Form
MPCA Lic. # 654
Maintainer Jim
Duane
.Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee:
Ne/:��
ason For Pumping:
❑Other (see attached
❑ Yes l�'(�o
�s ❑ No
O Risers leaking
❑ Risers leaking
Long Pull Fee:
75 do
❑ Elevated drainfield
Address:
33'7
tt
❑ Baffles
Other Repairs:
❑ Non-domestic waste
City/State/Zip:
❑ Electrical issues
❑ Trenches
i
W �-� 40 W ,n
Li wt t�. ?�
Q� i'L-O
❑ Ponding/Surfacing
Total Cost of Service:ch
❑ Other:
Payment Method: ❑ Check ❑ Cash
❑ Credit
y7D
Comments:,
omments:,bvK+ �5Q r (' 3(LIP 154-
bvK5 -
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
2- eptic/holding Tank #1
❑ Yes or -1, o
❑ Yes P-rqo--
❑ Yes
No
Gallons: I LSb
holding Tank #2
�-
❑Yes
Gallons: o
Gallons:
El Yes M No
❑ Yes ❑ No
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
Ewi�umpTank
21-
Gallon
Gallons::� LSA
❑ Yes No
❑ Yes 0" No
❑ Yes
0
How Accessed:D Maintenance HoleScum/Sludge
Measured
Maintenance Holes Securely Replaced:7n,)
ason For Pumping:
❑Other (see attached
❑ Yes l�'(�o
�s ❑ No
Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e.,
cracked tanks. missina baffles. broken covers, etc.? If so, exolaln In comments below.
Tank #1 ❑ Yes o
Disposal:
Tank #2 ❑ Yes C No
Pump Tank ❑ Yes o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity0-Mound
O 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 Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:,
omments:,bvK+ �5Q r (' 3(LIP 154-
bvK5 -
Disposal: U Lams MIJIJIIGattuf l: L= VVGJtGwaltli uCaunci n r unt -- • r-t>'iJ7 r
Disposal Site: Lime: Gallons Z SL-7LO Plowed: ❑ Yes
rime: Temperature: pH: >12 ❑
Time: Temperature: pH: >12 0
011,
59
wo �- N