HomeMy WebLinkAboutSeptic Pumping 9.16.24Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 9 - 1 ce' 21/
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer Jim
ick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
Pumping Fee: L13 �. �
Name:
IIV V VII.0
Long Pull Fee:
Address:
Other Repairs:
City/State/Zip:
V-0 "_0
Total Cost of Servic
�rwk
Payment Method: ❑ Check
❑ Cash ❑ Credit
Tank (check if pr
Tank leaks below the
Tank leaks above the
Maintenance hole cover is damaged,
designed operating depth
designed operating depth
, crackedunsecured, or appears to be
structural) unsound
Septic/holding Tank #1
Gallo s: Is*-.90
❑ Yes El. -I �o
❑ Yes El -No
❑ Yes C
Septic/holding Tank #2
Gallons: Ca
❑ Yes No
❑ Yes ®'No
❑ Yes ❑ No
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Pump Tank
Gallons: L.&_o 0
❑ Yes No
❑ Yes No
❑ Yes l�No
How Accessed. Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
❑ Other (see attached) O'Yes ❑ No I❑ Yes ❑ No ice,
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks. missina baff7e.s. hrnken rnvarc atr 7 rf cn avnlain in rnm fr 1-
1-
Tank #1 ❑ Yes Oo
Tank #2 ❑ Yes ONo
Pump Tank ❑ Yes o
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: ❑'r-a-nd Application: ❑ Wastewater Treatment Plant
Disposal Site: U (
Lime:
Gallons Z_2z>
Plowed:
❑ Yes
121_1 o
Time:
Z i 7
Temperature: z 0, /
pH:
Z� z
> 12 O'
Time:
Z z(7
Temperature: Z 0, (�
pH:
2 - L
> 12 :ff-
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