HomeMy WebLinkAbout08-22-22 Septic Maintenance InspectionSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
nATEQ-Z2—Z-Z.•
Maintenance Inspection Form
MPCA Lic. # 654
Maintainer = Jim
Duane
Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee: $
Scum/Sludge Measured
Name:
Reason For Pumping:
❑ Other (see attached)
El Yes CXNo
L G � �% ` Gam✓
ff VV-' �
O Risers leaking
� i' 4�
1
❑ Elevated dralnfield
❑ Baffles
Long Pull Fee:
EI Baffles
❑ Pressure bed
Address:
❑ Non-domestic waste
❑ Electrical issues
❑ Trenches
❑ Non-domestic waste
❑ Ponding/Surfacing
❑ Effluent Filter/screen
Other Repairs:
City/State0p:
Comments;
Total Cost of Service:
lei
Payment Method:
Check ❑ Cash
4
El Credit
7
y &D
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
structurally
unsound
tic/holding Tank #1
Gallons: (,)9LR)
❑ Yes
ffNgo _
❑ Yes
e -K-0
❑ Yes
t5 No
C�Septic/holding Tank #2
d No
❑Yes
C3-Klo_
Gallons: l�J
❑Yes'Co
❑Yes
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
lump Tank
No
11Yes
Gallons: yD&�)
❑ Yes
ff No
❑ Yes
How Accessed; aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
El Yes CXNo
Yes ❑ No
ff VV-' �
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, exDlain In comments_be4ow.
Tank #1 ❑ Yes p4lqo
Tank #2 ❑ Yes o
Pump Tank ❑ Yes EYN o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
ffWound
O Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevated dralnfield
❑ Baffles
❑ Baffles
EI 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: ❑ Land Application: wastewater Treatment Plant Lv`4&4,-A
Disposal Site: Lime:
Gallons
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
>12 ❑
Time:
Temperature:
pH:
> 12 ❑
gum
OA -11