HomeMy WebLinkAbout4645 Saint Andrew Street - Septic Pumping ReportSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE % ( 104�
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer Jim
0 Nick
0 Sam
® Phone: 763-497-2764
® Email: du anesepticCcenturylink.net
INVOICE
Pumping I
Name: (?
Long Pull
Address: Ll
U
Other Rer
City/State/Zip:
b 'f°�`�
Total Cosi
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Payment Method: ❑ Check ❑ Cash ❑ 'Credit
Tank leaks above the
Maintenance hole cover is damaged,
< leaks below the
Tank
operating
depth
designed operating depth
cracked, unsecured, or appears to be
structural) unsound
RI/Se Tank #1
❑ Yes
12-IN o
❑ Yes No
❑ Yes r<No
Gallons:
Z"Septic/holding Tank #2
❑Yes
l; No
❑ Yes ❑�fVo
❑ Yes B''
Gallons:
O
❑ Pretreatment Tank
Gallons:
r
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Pump Tank
El Yes
No
,�
El �No
❑Yes
Gallons:
9Ao
ssed:❑ Maintenance Hole
r!�!!
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
❑ Yes ❑ No
❑ Yes ❑ No
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: -0- Land Application: ❑ Wastewater Treatment Plant
Disposal Site: \'\'
Lime: i
Gallons ;; %`` '
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: j ; > 12 ❑
Time: n
Temperature:
pH: > 12 0