HomeMy WebLinkAboutSeptic Pumping 9.5.24 2Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE q --5— 2 7
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer ❑ Jim
Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink,net
Pumping Fee: (lt2-�
Name: �0 I
; C1Ae'e l
Long Pull Fee:
Address:
1
✓� I" L b'1
Other Repairs:
City/State/Zip:
Our ®YA0
Total Cost of Servic
;1
Payment Method:
❑ Check ❑ Cash
❑ Credit
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
h
designed operating
depth
,
structural)
unsound
El"Septic/holding Tank #1
Gallons: � ��
El Yes
Eil o
El Yes
�o
❑ Yes
No
In"
Septic/holding Tank #2
Gallons: ['0.9 0
El
��
❑ Yes
/
eNo
❑ Yes
❑ Pretreatment Tank
Gallons:
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Pump Tank
Gallons: 10 &0
❑ Yes
No
❑ Yes
�No
❑ Yes
C�o
How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
ElOther (see attached) es ElNo 9—Y-es ❑ No ivv�• ✓t
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missino baffles. broken rctrecs. etc. 2 rf an. exnlain in rnmmantc LwTrn w
Tank #1 ❑ Yes FA o
Tank #2 ❑ Yes o
Pump Tank ❑ Yes o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
RrMound
❑ 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: 6 Lid Application: ❑ Wastewater Treatment Plant
Disposal Site: IV\\
Lime:
Gallons 3cao
Plowed:
❑ Yes
(?<O
Time:
Temperature: c,-7
pH:
Z, 2--
> 12
Time:
Temperature: Zq_ 0
pH:
t Y 2-
> 12
� '.� fir �'� �r�/ •� � ���; '-�.-�.� Cyr • �', ��,r�/" •� •
�'�s�-