HomeMy WebLinkAbout3445 Watertow Rd Maintenance Inspection form, Aug 2023DVANE�
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 552376
M ATC
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer ❑,Jim
Nick l
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INV01r.F
Pumping Fee:
Name:
Long Pull Fee:
Address: I L G 5d
w
Other Repairs:
City/State/Zip:
Total Cost of Service: /
Payment Method: ❑ Check ❑ Cash ❑ Credit
r
Tank (check i resent)
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
(eSeptic/holdip g Tank #1
❑ Yes
LYNO
❑ Yes E/No
❑ Yes ["lo
Gallons: t27 0
eptic/holding Tank #2
Gallons: U, - f
❑ Yes
QNo
❑ Yes O No
❑ Yes t/No
❑ Pretreatment Tank
It,
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
Pump Tan�k._,_,�.
�
Gallons: 3a a
❑ Yes
C///N0
❑ Yes V"No
❑ Yes DIKO
How Accessed: n Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
❑ Other (see attached) ❑ Yes -E No I EJ/Yes ❑ No n 'f"l
Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e.,
14 F .,, ccinn hnrf)cc hrnlran rnuerc. etr.7 Tf so. EXnlaln In comments below.
Tank #1 ❑ Yes 9 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: ❑ Land Application: VrWastewater Treatment Plant W AT-tr7bw'\.
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
> 12 ❑
Time:
Temperature:
pH:
> 12 ❑
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