HomeMy WebLinkAbout8-19-24 Septic Pumping ReportSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 24
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer ❑ Jim
Nick
Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
Pumping Fee:
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Name:
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Long Pull Fee:
Address:
Other Repair
City/State/Zip:
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8 IS
Total Cost of ervice:
Payment Method: ❑ Check ❑ Cash
❑ Credit
53 l
YOU -
Tank (check if present)
Tank leaks below the
Tank leaks above the
Maintenance hole cover is damaged,
crackedunsecured, or appears to be
designed operating depth
designed operating depth
,
structural)
unsound
�ptic/holding Tank #1
❑ Yes
n No
ElYes
Gallons:
ElYes
No
❑ Septic/holding Tank #2
Gallons:
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
ElYes ElNo
ElYes
❑ No
El"Pump Tank
Gallons: j j��
El Yes
No
El Yes No
El Yes
f�No
How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
❑ Other (see attached) es El No el Yes ❑ No S e
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missina baffles, broken covers, etc.? Ifso. exolain in comments- low.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes ❑ No
Pump Tank ❑ Yes No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
ETMound
❑ 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: K-Wastewater Treatment Plant VtkW-' +'k- -
Disposal Site:
Lime:
Gallons f3 6-0
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
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