HomeMy WebLinkAbout387 Orono Orchard Rd, Maintenance Inspection form, Aug 2023Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
Maintenance Inspection Form
MPCA Lic. #1_4286
Maintainer 1 Jim
❑ Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee:
Name:
Long Pull Fee: � �C
Address: �a-? 6
folio v /-C t") nor
Other Repairs: �
U
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City/State/Zip:
CQuv-.
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Total Cost of Service: 4- A
1110
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
structural) unsound
Septic/holding Tank #1
❑ Yes
��
®"No
❑ Yes No
❑ Yes No
Gallons: � j,�
peptic/holding Tank #2
❑ Yes
Zf No
❑ Yes 0_1qo
❑ Yes
Gallons: 1000
❑ Pretreatment Tank
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
Pump Tank
❑ Yes
P-N-0
❑ Yes No
❑ Yes No
Gallons: I oUv
How Accessed. aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached) 1
❑ Yes o
es ❑ No
Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, he.,
—f—d f,nt,, mtcelnn haff nc hrnlepn rnvarc, atc.7 if So. exnlaln In comments below.
Tank #1 ❑ Yds ZWo
Tank #2 ❑ Yes f5No
Pump Tank ❑ Yes o
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: ❑ Land Application: D Wastewater Treatment Plant L, 3 0 .- , . --w "'—
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
> 12 ❑
Time:
Temperature:
pH:
> 12 ❑