HomeMy WebLinkAboutSeptic Pumping 9.4.24 1Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376/
DATE cl -�yZY
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer ❑ Jim
lick
• Phone: 763-497-2764
• Email: duaneseptic9centurylink.net
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Pumping Fee:
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Name:
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s
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Long Pull Fee:
Address:
7-S$0 Fix 5�-
Other Repairs:
City/State/Zip:
®WpVXi)
Total Cost of Service
—
Payment Method: GFCheck ❑ Cash
❑ Credit
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qc, z 5v
Tank check if resent
p
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
C�-tic/holding Tank #1
Gallons: ( ZS-o
❑ Yes
❑lo
�
El Yes ❑ No
❑ Yes
Cf'Iq_o
Septic/holding Tank #2
❑ Yes
No
❑ Yes
Gallons: t 2S-o
No
❑ Yes
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ NNoo
El Yes El No
El Yes
El No
Pump Tank
;�N�o
Gallons: I Z
❑Yes
C�
El
❑ Yes
❑._ doo
W
How Accessed: aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
2- es El No
Cf"Yes ❑ No
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.? Ifso, explain in comment low.
Tank #1 ❑ Yes 2flo
Tank #2 ❑ Yes No
Pump Tank ❑ Yes No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
❑ �Mou�nd
ElRisers leaking
ElRisers leaking
❑ Risers leaking
Q 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: 2TWastewater Treatment Plant t ,11-4e- -'V t
Disposal Site:
Lime:
Gallons .3 e-s' 0
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 0