HomeMy WebLinkAbout710 North Shore Drive West - Septic Pumping ReportSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 5 - ` - Z-5'
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
'Nick
0 Sam
® Phone: 763-497-2764
® Email: duaneseptic@centurylink.net
innintrc
Pumping Fee:
Name:
d
Long Pull Fee:
Address:
'7(0 tv?
Other Repairs:
City/State/Zip:
Total Cost of Ser
14
Payment Method: ❑ Check ❑ Cash
❑ Credit
Tank leaks above the
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
elow the
Tank (check if
_ sting depth
designed operating depth
structural)
unsound
Septic/holding Tank #1
Gallons:
❑Yes El No
❑Yes El No
El Yes
El No
Z'Septic/holding Tank #2
Gallons: t 9
❑ Yes El No
❑Yes ❑ No
El Yes
El No
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Pump Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
How Accessed: Maintenance Hole
cum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
ElOther (see attached)
rElYes ❑ No
❑ Yes ❑ No
v e-
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missing baffles, broken covers, etc.? Ifso, explain in comments below.
Tank #1 ❑ Yes ❑ No
Tank #2 ❑ Yes ❑ No
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
❑ Trenches
❑ Non -domestic waste
❑ Ponding/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: ❑ Land Application: C2' I6Vastewater Treatment Plant
Disposal Site:
Lime:
Gallons 11.00
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
,./''� � .sue.. �' ,✓�-� �`'�" sue.