HomeMy WebLinkAboutSeptic Pumping 9.11.24Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 9 -11- Z4
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer ❑ Jim
*N ick
• Phone: 763-497-2764
• Email: duaneseptic9centurylink.net
Pumping Fee:
Name:
IIY V VIIiG
Long Pull Fee:
Address:
7
Other Repairs:
City/State/Zip:
Total Cost of Servi
i �av`
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
designed operating
depth
,
structural)
unsound
���
i�'Septic/holding Tank #1
Gallons• s,�o
El Yes �f No
❑ Yes
,L�'No
❑Yes
No
271 eptic/holding Tank #2
❑ Yes No
❑ Yes
-11
Gallons: 90-0
No
❑ Yes
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
/Pump Tank
Gallons: 6,4;Eo �,JJ
❑ Yes No
❑ Yes
Jeil_No
❑ Yes
How Accessed: aintenance Hole Scum/Stud e Measured Maintenance Holes Securely Replaced: Reason For Pumping:
❑ Other (see attached) ❑ es ❑ No El-les ❑ No "AC"
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
c acked tanks. missing haffTps_ hrnkpn rn�m Ptr 7 TFcn Pvnlain in rnrnrr tP ha/.,u
Tank #1 ❑ Yes o
Tank #2 ❑ Yes Yfro
Pump Tank ❑ Yes No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
ound
❑ 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: �d Application: ❑ Wastewater Treatment Plant
Disposal Site: V
Gallons'Z 1cQ-3
Plowed: ❑ Yes
❑-K-0
Time: 5� "�
Temperature:
ZD,I
pH: 2. Z
> 12
Time: t Z Z -7
Temperature:
,,P' -?"
pH: l L. I
> 12
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