HomeMy WebLinkAbout 4-30-24 septic pumping report icher
Maintenance Inspection Form
MP/CA Lic. #L4286
Maintainer I� Jim
❑ Nick
Service, LLC • Phone: 763-497-2764
aBeaux Ave NE
lad, MN 55376 • Email: duaneseptic@centurylink.net
q,3.0 ..2q INVOICE
g Fee: ` f U ca° (yi:* ,4 Name:
all Fee: 50 2- 140 oto L1I Address: SLil �%r tic
epairs: City/State/Zip:
)st of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit
Qi Si ;.)- ' E;)
Maintenance hole cover is damaged,
Tank leaks below the Tank leaks above the cracked, unsecured,or appears to be
ink(check if present) designed operating depth designed operating depth
structurally unsound
;Molding Tank#1 ❑ Yes 0'No ❑ Yes No El Yes CiNo
i��
/holdin Tank#2 ❑ Yes prgO ❑ Yes CrNo ❑ Yes No
:atment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
Tan ❑ Yes7 No ❑ Yes `Cl No El Yes �l No
S
3essed:4aintenance Hole Scum/Sludge Measured Maintenance oles Securely Replaced: Reason For Pumping:
❑Other(see attached) ❑Yes No C es El No "�.
Did you identify a operational issues or unsafe conditions while assessing the sewage tanks In this system, i.e.,
cked tanks,missing baffles, broken ers, etc.?If so, explain in commentsow.
❑ Yes No Tank#2 ❑ Yes No Pump Tank ❑ Yes ."-"No System s�
G�
Structural integrity ❑ Structural integrity ❑ Structural integrity 'fNound
Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield
Baffles ❑ Baffles ❑ Baffles El Pressure bed
Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑ Trenches
❑ Non-domestic waste ❑ Ponding/Surfacing
❑ Effluent Filter/screen ❑ Other:
Cleaned? ❑Yes 0 No
nts:
Disposal: ❑ Land Application: ll Wastewater Treatment Plant V/A-T,.tr t U
il Site: Lime: Gallons Plowed: ❑ Yes ❑ No
Temperature: pH: >12 O
Temperature: pH: >12 ❑
0 (431.140 THANKS! ,0.1
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