HomeMy WebLinkAboutPumping Report 6-25-24Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE Z S Z '-/
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer Q Jim
lick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVC)lrF
Pumping Fee:Name:
�2
Tank #2 ❑ Yes No
Pump Tank ❑ Yes No
S4(2Ue
C' -
Scum/Sludge Measured
Long Pull Fee:
c
ElOther (see attached)
Address:
=
Vl.� L_
Other Repairs:
EY -Baffles
❑ Baffles
City/State/Zip:
❑ Non-domestic waste
❑ Non-domestic waste
❑ Electrical issues
❑ Trenches
❑ Non-domestic waste
❑ Ponding/Surfacing
Total Cost of Se e:
❑ Effluent Filter/screen
❑ Other:
Payment Method: ❑ Check ❑ Cash
❑ Credit
r
Comments:
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
Gallons: � 2
❑ Yes
rJ No
El Yes �o
El Yes
®-90
Septic/holding Tank #2�
#2E)
Yes
No
❑Yes ❑'No
11 Yes
o
Gallons: 2 So
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
El Yes El No
El Yes
❑ No
Pump Tank
/�
❑
❑
2 -No
Gallons: 12-510
❑ Yes
Z_ No
Yes
Yes
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missino bafFles, broken covers, etc.? Ifso, explain in comments -below.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes No
Pump Tank ❑ Yes No
System
How Accessed: Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
ElOther (see attached)
0 es El No
❑Yes ElNo
Vl.� L_
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missino bafFles, broken covers, etc.? Ifso, explain in comments -below.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes No
Pump Tank ❑ Yes No
System
El Structural integrity
El Structural integrity
El Structural integrity
ound
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevated drainfield
❑ Baffles
EY -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: r1 _Wastewater Treatment Plant
Disposal Site:
Lime:
Gallons ,-: jba
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
> 12 ❑
Time:
Temperature:
pH:
> 12 ❑