HomeMy WebLinkAbout4660 Bayside Road - Septic Pumping ReportMaintenance Inspection Form
DUANE*�
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE (0 - Z c' _-125
MPCA Lic. #L4286
Maintainer 0 Jim
rsIck
am
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee:
Name:
j
Address: 1,
Long Pull Fee:
Other Repairs:
City/State/Zip:
Total Cost of Se
l Gt,�f%�
Payment Method: ❑ Check ❑ Cash ❑ Credit
J-1
Tank leaks above the
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
below the
Tank (check__
—
--�ezrgnaa-uperating depth
designed operating depth
structurally unsound
❑,. eptic/holding Tank #1
❑ Yes ❑ lo_
El Yes O oN
❑ Yes ❑-9
Gallons: ,�Qo
eptic/holding Tank #2
❑ Yes C9' No
❑ Yes 2--No
❑ Yes ❑ No
Gallons: I sL"
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
E Pump Tank
�lo
❑ Yes ef" No
❑ Yes ff No
Gallons: i,p ego
❑ Yes
How Accessed: Maintenance Hole
El Other (see attached)
Scum/Sludge Measured
f1'Yes ❑ No
Maintenance Holes Securely Replaced:
es ❑ No
Reason For Pumping:
�- L ✓Ly
Did you Identlfy any operational issues or unsafe conditions while assessing the sewage tanks In this system, I.e.,
hacked tanks, missing baffles, broken covers, etc.? If so, explain In comments below.
Tank #1 ❑ Yes No
Tank #2 ❑ Yes No
Pump Tank ❑ Yes ZI No
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: Ei<a—nd Application: ❑ Wastewater Treatment Plant
Disposal Site:
Time:
V Lime:
7,0"-1
Gallons j
Temperature:
Plowed:
pH:
❑ Yes
DINO
> 12 Br'
Time:
z 17Temperature:
j'1- `I
pH:
> 12 113