HomeMy WebLinkAbout2990 Sussex Rd Orono reportSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 553761
DATE '4--f 2- 2-'7
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer P Jim
ick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
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Pumping Fee:
Scum/S�ludd e Measured
Maintenance Holes Securely Replaced:
Name: _
El Other (see attached)
2 -les El No
0 Yes ❑ No
["L'L
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevated drainfield
Long Pull Fee:
❑ Baffles
❑ Baffles
Address :*�c
❑ Non-domestic waste
❑ Non-domestic waste
❑ Electrical issues
❑ Trenches
10r
❑ Non-domestic waste
Other Repairs:
City/State/Zip:
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Total Cost ofS Ice:
Payment Method: ElCheck El Cash
El Credit
�3 7 ��
< leaks
below the
Tank leaks above the
Maintenance hole cover is damaged,
Tank (check i ent)
designed
operating depth
designed operating depth
cracked, unsecured, or appears to be
structural)
unsound
Septic/holding Tank #1
El Yes
L'iVo
❑Yes Lf No
El Yes
9_<0_
Gallons:,L�-�
eptic/holding Tank 42
Yes
11 -No
Yes
Yes
Gallons: o-e1v
❑
❑ C3�No
❑
C�No
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes
❑ No
0-15'Ump Tank
❑Yes (��tGo
Gallons: t, a 0 0
El Yes
o
❑Yes
L�(lo
How Accessed: VVaintenance Hole
Scum/S�ludd e Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
El Other (see attached)
2 -les El No
0 Yes ❑ No
["L'L
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
Cprked tanks, missing baffles, broken Sowers, etc.? If so, explain in commentsj;�e'fow.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes r1N o
Pump Tank ❑ Yes Eilno
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
ZT Mound
❑ 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: and Application: ❑ Wastewater Treatment Plant
Disposal Site: L4 7Lime: Gallons1 Plowed: ❑Yes C3�o
Time: 3 7 Temperature: , ✓ pH: Z > 12
Time: VTemperature: , c' pH: I Co > 12
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