HomeMy WebLinkAbout2875 Wear Circle - Septic Pumping ReportouANE*�
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE % 0 - (7 - a
Maintenance Inspection Form
MP Lic. #L4286
Maintainer Jim
Nick
Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee:
Name: / t
VVIZvi
Address:
Long Pull Fee:
Other Repairs:
City/State/Zip:
-�� D
Total Cost of Serv�¢
J
Payment Method: ❑ Check ElCash ❑ Credit
Tank leaks above the
Maintenance hole cover Is damaged,
Tank leaks below the
Tank (check if pre;
designed operating depth
designed operating depth
cracked, unsecured, or appears to be
structural) unsound
optic/holding Tank #1
❑ Yes
eNo
El Yes No
El Yes ❑ No
Gallons:
optic/holding Tank #2
'Co
Gallons:
❑ Yes
❑ Yes No
❑ Yes V'No
❑ Pretr atment Tank
❑Yes
❑ No
❑Yes ❑ No
❑Yes ❑ No
Gall s:
Pump Tank
❑ Yes
No
❑ Yes o
❑ Yes ❑ No
Gallons:
How Accessed: aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason F Pumping:
❑ Other (see attached)
El Yes 11 No
es ❑ No
Did you Identify any operational Issues or unsafe conditions w -assessing the sewage tanks In this system, i.e„
cLaekcfd tanks, missing baffles, broken co , etc.7 If so, explain In comments b�
Tank #1 ❑ Yes Pflo
Tank #2 ❑ Yes EWo
Pump Tank ❑ Yes o
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
❑ Pond! ng/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: _--M-Land Application: ❑ Wastewater Treatment Plant
Disposal Site: V t
Lime:
Gallons
`,��
Plowed: ❑ Yes
--ErN
Time: I I 5 t
Temperature:
(, Z
pH: t z,
> 12 ❑
Time: t O I-
Temperature:
pH: t -?_ �"
> 12 0