HomeMy WebLinkAboutSeptic Pumping 9.26.24Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE q- 2G-z4
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer = Jim
'Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
Pumping Fee:
_j z -,S'--3
Name:
50A.0 kA
IIY V VI%,L.
Long Pull Fee:
Address:
Other Repairs:
City/State/Zip:
Total Cost of Service:
Payment Method:
Check ❑ Cash
❑ Credit
�S 7.
SQ
73
$S-s% 50
ou
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
structurall
unsound
���
u'Septic/holding Tank #1
Gallons:[ e,,L->
❑ Yes to
❑ Yes
0- o
❑ Yes
Er -No
Septic/holding Tank #2
Gallons: �a,3,�
❑ Yes E� o
❑ Yes
❑'No
❑ Yes
❑�o
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Pump Tank
Gallons:
El ElNo
ElYes
ElNo
ElYes
❑ No
How Accessed: P119 aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
El Other (see attached)
Yes ❑ No
Ett es ❑ No
.4 .i n
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks In this system, i.e.,
-cracked tanks. missino baffles. broken carders. etc 7 Tf sn. exnlain in rnmmanl-c ha/nw
Tank #1 ❑ Yes ZNo
Tank #2 ❑ Yes o
Pump Tank ❑ Yes ❑ No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
❑ Mound
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevated drainfield
❑ Baffles
❑ Baffles
❑ Baffles
❑ Pressure bed
❑ Non -domestic waste
❑ Non -domestic waste
❑ Electrical issues
- enches
❑ Non -domestic waste
❑ Ponding/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: ❑ Land Application: ❑- astewater Treatment Plant
Disposal Site:
Lime:
Gallons ISM
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
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