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HomeMy WebLinkAbout 4-24-24 septic pumping report cher Maintenance Inspection Form MPCA Lic. #L4286 Maintainer ❑ Jim ►l ick Service, LLC • Phone: 763-497-2764 Beaux Ave NE ael, MN 55376 • Email: duaneseptic@centurylink.net 4i." 2 S- 2' INVOICE Fee: Name: (-i, Zs. 0 k.ky t 5 -3-- -1 5 I Fee: Address: pairs: 'City/State/Zip: C L \. n ��,l� I.\ vt�Q,A 0 st of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit 433 -7.sc- Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, k(check if pre �� designed operating depth designed operating depth cracked, unsecured,or appears to be structurally unsound Bolding Tank#1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No c Bolding Tank#2 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Lcy tment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Eank ❑ Yes 0 No ❑ Yes ❑ No ❑ Yes ❑ No a t% )ssed:❑Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: lcle;J .}c,..k S ❑Other(see attached) ❑ Yes ❑ No ❑ Yes 0 No ;:, .t �y Did you identify any operational issues or unsafe conditions while assessing the sewage tanks In this system,i.e., cracked tanks, missing baffles, broken covers,etc.?If so, explain in comments below. ❑ Yes ❑ No Tank#2 ❑ Yes ❑ No Pump Tank ❑ Yes ❑ No System tructural integrity ❑ Structural integrity ❑ Structural integrity ❑ Mound lisers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield 'raffles ❑ Baffles ❑ Baffles ❑ Pressure bed Ion-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑Trenches ❑ Non-domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No ts: Disposal: ❑ Land Application: O stewater Treatment Plant I Site: Lime: Gallons 7.04,r-) Plowed: 0 Yes ❑ No Temperature: pH: >12 ❑ Temperature: pH: >12 0 esilD THANKS! ,. ,, els • �`',r sue. --� ,. -'�-�, �`'� .sue.