HomeMy WebLinkAboutSeptic Pumping 9.5.24 1Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376 l,
DATE c �_ * V
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer ❑ Jim
Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
IN1/r)IrF
Pumping Fee:
Name:
Long Pull Fee:
Address:
f
Other Repairs:
City/State/Zip:
Total Cost of Se ice:
I au\ V
Payment Method: ❑ Check ❑ Cash ❑ Credit
`D�
_
S
®1t
Tank (check if presen
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: to 0-0
❑ Yes
No
❑ Yes No
❑ Yes ❑ No
Septic/holding Tank #2
Gallons:
❑ Yes
No
❑ Yes e No
❑ Yes M No
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
71�ump Tank
Gallons: lL7,�>d
❑ Yes
ZINo
❑ Yes E:4-No
❑ Yes L_No
How Accessed. Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
El Other (see attached)
rrYes El No
2' s ❑ No
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
racked tanks, missing bafFles, broken c vers, etc.? If so, explain in commen elow.
Tank #1 ❑ Yes No
Tank #2 ❑ Yes o
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: O'15and Application: ❑ Wastewater Treatment Plant
Disposal Site: t/vt t
Lime:
Gallons z-fv-,)
Plowed:
❑ Yes 2<0
Time:
Lr
Temperature: i q `7
pH:
2_ L > 12
Time:
Temperature: ZO, 0
pH:
t.y > 12 Fer