HomeMy WebLinkAboutSeptic Pumping 9.23.24Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE / 1 ?,3
Maintenance Inspection Form
�Jcim"Iic. #L4286
Maintainer
❑ Nick
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
Pumping Fee: >
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Name:
Long Pull Fee:
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Address:
Other Repairs:
City/State/Zip:
Total Cost of Servi
S74 5o _)
Payment Method:
Check ❑ Cash
❑ Credit
Tank (check if present)
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
structurally
unsound
eptic/hold! Tank #1
Gallons: fr
❑ Yes
C to
❑ Yes
ETIN o—
❑ Yes
1�ro`
Septic/hold! Tank #2
Gallons jo U'd
❑Yes
❑Yes
No
❑Yes
❑ Pretreatment Tank
Gallons:
❑ Yes
❑,No-
El Yes
ElNo
❑ Yes
❑l No
Pump Tank
El Yes
el No
El Yes
❑
rC]
Gallons: 5(dp
El Yes
No
How Accessed. aintenance Hole Scum/Sludge Measured
�-- Maintenance
--H`olles Securely Replaced: Reason For Pumping:
ElOther (see attached) ❑ Yes -41 reo ��'Yes ❑ No
u,o you ,aent,ry an -operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
eked tanks, missino baffles, broken covers —etc.? Tfsn. exnlain in rnmmPnhc hal, w
Tank #1 ❑ Yes No
Tank #2 ❑ Yes o
Pump Tank ❑ Yes EFo
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
0 Mound
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevated drainfleld
❑ Baffles
❑ Baffles
❑ Baffles
❑ Pressure bed
❑ Non -domestic waste
❑ Non -domestic waste
❑ Electrical issues
❑ Trenches
❑ Non -domestic waste
❑ Pond! ng/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: -❑ Land Application: ❑ Wastewater Treatment Plant
Disposal Site: E
Lime: _
Gallons 1. _ .jt_,
Plowed: ❑ Yes -❑ No
Time: t
Temperature:
pH: > 12:-❑
Time: 3, ; 5 . 5
Temperature: y
pH: > 12 ❑