HomeMy WebLinkAbout2845 Wear Circ Maintenance Inspection form, Aug 2023Maintenance Inspection Form
DVANE*
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 8-- 25" = 23
MPCA L4286
Maintainer Jim
0 Duane
<$FNick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
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Pumping Fee:
Name:
Long Pull Fee:
Address:
t/ i _
Other Repairs:
City/State/Zip:
Total Cost of Servic •
Payment Method: ❑ Check ❑ Cash ❑ Credit
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: Cc,>t> 0
❑ Yes
❑ Yes 9'170—
❑ Yes Rr Vo
EY'Septic/holding Tank #2
❑ Yes
Ge
❑ Yes �o
❑ Yes
Gallons: CQ
o
2__l o
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ umpTank
Gallons: f V ,,,>
❑ Yes
j
❑ Yes -E No
❑ Yes e"No
How Accessed: Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
ElOther (see attached)
❑ Yes 11_*�No
GT//Yes ❑ No
. (n
Did you Identlry any operational Issues or unsafe condltlons while assessing the sewage tanks In this system, l.e,,
racked tanks, missing baffles, broken c vers, etc.? Ifso, explain In comments ow.
Tank #1 ❑ Yes No
Tank #2 ❑ Yes o
Pump Tank ❑ Yes No
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 Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: ETILand Application: ❑ Wastewater Treatment Plant
Disposal Site:
Y
Lime: "�
Gallons Z, /
Plowed:
❑ Yes
ET No
Time:
/
Temperature: 9,
pH:
2- i
> 12
Time:
Temperature: I 5.V
pH:
2.•Z
>12 45