HomeMy WebLinkAbout3425 Watertown Road - Septic Pumping ReportSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE ' - ? 2
Pumping Fee:
Lonq Pull Fee:
er
Total Cost of Servi
Maintenance Inspection Form
MPCA -ic. #L4286
Maintainer Jim
Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOI
(f t Name: 'f f
Address: 4'
9()
City/State/Zip: /
/, �t , j7^�l s
Payment Method: ❑ Check ❑ Cash ❑ Credit
Maintenance hole cover is damaged,
�w the
Tank (check if pG_�a..T— - -- -
Tank leaks above the
cracked, unsecured, or appears to be
designed operating depth
designed operating depth
structural) unsound
eptic/holding Tank #1
El Yes ❑ No
❑Yes ElNo
El Yes ElNo
Gallons:
;;i�eptic/holding Tank #2
El Yes ❑ No
I--] Yes ElNo
El Yes ElNo
Gallons:
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
❑ Pu ank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
ons:
How Accessed: ❑ Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
❑ Yes ❑ No
❑ Yes ❑ No
AA in �ca,Pt
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.? If so, 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: P"Wastewater Treatment Plant i-'&
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
Jirr
Maintenance Inspection Form
MPCA Lic. #L4286
SeF.
1205 L,
St. Michas
DATE S
Maintainer 0 Jim
J�,-N
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee.
Name:
Address: -2 r ;
Cc� `5 � �=Cj
Long Pull Fee:
- . L «� � c
V_
City/State/Zip:
Other Repairs:
0
Total Cost of Se
��t�vnr
Payment Method: ❑ Check ❑ Cash
❑ Credit
Tank leaks above the
Maintenance hole cover is damaged,
oelow the
Tank (check--,,- _
____
esign ating depth
designed operating depth
cracked, unsecured, or appears to be
structural) unsound
Septic/holding Tank #1
Gallons: 2j
El Yes
El Yes C �10
El Yes
No
Septic/holding Tank #2
ElYes KINo
ElYes No
❑ Yes
Gallons: L 3 y:,,
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
--Gallons:
GI'ump Tank
'Co
❑
El Yes
C�"No
Gallons: (�
El Yes 2'
Yes No
-
M
How Accessed: ETMaintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
M-Yes El No
e Yes ❑ No
6. `4
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
Spcked tanks, missing baffles, broken fivers, etc.? If so, explain in comment low.
Tank #1 ❑ Yes Ugo
Tank #2 ❑ Yes o
Pump Tank ❑ Yes ❑ o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
2Mound
❑ 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: 1?1lastewater Treatment Plant
Disposal Site:
Lime:
Gallons 7 700
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
'-�.-•z cam' � � .� • �. •-9�.� C�r'� �.
s�.-
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE
Pumping Fee:
Long Pull Fee:
Other Repairs:
Total Cost of Se
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
"Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Name: t " lG u �
Address: / -
ZED ��
City/State/Zip:
CD w'- -"-D
Payment Method: ❑ Check ❑ Cash ❑ Credit
Tank (check T, errq —_— -- - Below the
Tank leaks above the
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
designed operating depth
designed operating depth
structural) unsound
l�ptic/holding Tank #1
Gallons: [ a�z.�
El Yes 9
El Yes �o
❑Yes Vo
E;�eptic/holding Tank #2
❑ Yes
Gallons: t __c,_e
No
❑ Yes No
❑ Yes 4-ft
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ElNo
❑ Yes ElNo
ump Tank
❑Yes 2 No
❑ Z
Gallons: L '- ��'
Yes No
❑ Yes
How Accessed: aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
2- es ❑ No
�s ❑ No
rn'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- overs. etc.? Ifso. explain in comments below.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes 'No
Pump Tank ❑ Yes o
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: 2TGnd Application: ❑ Wastewater Treatment Plant
Disposal Site: 1f` l
Lime: /
Gallons Z-��
Plowed: ❑ Yes
EfiiVo
Time:
2 -7
Temperature:
j y, "�
pH: j 2_
> 12 '
Time:
�iS "�
Temperature:
( , I
pH:
> 12 ET
�.� Cyr '�t / •�Jt �"� Q� J® '�.-.� Cam• '� / •i� �.`�
.,.�'`•�'� �''� sue. �'-' ,✓'`'�'�, �'� ��-
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 1 1- (3- 7--SK-
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
1ntvn1r1`
Pumping Fee.
Name:
Long Pull Fee:
Address:
Other Repairs:
City/Sta
Total Cost of Serv'
Paymen e o K Check ❑ Cash
❑ Credit
�H
Tank leaks above the
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
ow the
Tank (check if F
- ----
__ ing depth
designed operating depth
structural)
unsound
eptic/holding Tank #1
Gallons: 0 <
❑ Yes C3'Iq_o_
❑ Yes 13_ 10
❑ Yes
❑ Septic/holding Tank 12
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ElNo
❑ Yes
❑ No
Q,P'ump Tank
jj
Gallons: L
❑ Yes !o No
❑ Yes a/No
❑ Yes
I
ssed: Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
r��ElOther (see attached)
hi Y/es ❑ No
Wres ❑ No
Ito -V L'_ �. _j-
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missing baffles, broken vers, etc.? Ifso, explain in comments below.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes
Pump Tank ❑ Yes o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
and
❑ 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: 9 and Application: ❑ Wastewater Treatment Plant
Disposal Site: L'i
Lime:
Gallons 2 l a-O
Plowed:
❑ Yes
Ebb
Time: L. 3 v
Temperature: fq
pH:
_ q
> 12 -0—
Time:
Temperature: f 4, �
pH:
_ '
> 12
,_/'`�'� �`''� sue• .�','`'. ,✓'-'� �`'`� s�-
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE
Maintenance Inspection Form
MZim
Lic. #L4286
Maintainer
Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOIrF
Pumping Fee:
Name: P
Long Pull Fee:
Address:
Other Repairs:
City/State/Zip:
Total Cost of Servio
Payment Method: ❑ Check ❑ Cash
❑ Credit
— _`,m7uaKs o Ow the
Tank leaks above the
Maintenance hole cover is damaged,
Tank (check if presew-
designed operating depth
designed operating depth
cracked, unsecured, or appears to be
structurally
unsound
eptic/holding Tank #1
No
Gallo . ( �
ElYes No
❑ Yes C�' o
ElYes
Septic/holding Tank #2
Yes
i No
Gallons: �� C✓L
❑ Yes No
❑ Yes C-No
❑
E
❑ Pretr atment Tank
Ga
El Yes El No
❑Yes ❑ No
❑Yes
❑ No
s:
❑ Pump Tank
Gallons:
El Yes No
El Yes ❑��
El Yes
❑IAd�
(��
How Accessed:;Maintenance Hole
Scum/Sludge Measu/reds
Maintenance Holes Securely Replaced:
Reason ForPumping:
❑ Other (see attached)
El Yes C3 No
Yes ❑ No
--
Did you identify an perational issues or unsafe conditions i e assessing the sewage tanks in this system, i.e.,
ked tanks, missino baffles, broken rs, etc.? Ifso, explain in -bero
Tank #1 ❑ Yes P9,510
Tank #2 ❑ Yes EMo
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
❑ Ponding/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Disposal: ❑ Land Application: Z Wastewater Treatment Plant WA
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
Jim Eicher
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer Jim
ick
�
Sam
Septic Service, LLC
1205 LaBeaux Ave NE
- Phone: 763-497-2764
St. Michael, MN 55376
- Email: duaneseptic@centurylink.net
II" 25- z
DATE
INVOICE
Pumping Fee:
Name: € , rv,, S P6, VVx
Long Pull Fee:
Address: _��-- l� f- (._.
(
� r ,AOther
Repairs:
City/State/Zip:
6m)
Total Cost of Sear e:
FOyment Method: ❑ Check ❑ Cash ❑ Credit
�f�
iLesc_,
he
Tank leaks above the Maintenance hole cover is damaged,
Tank (check
-- — esigne operating depth
designed operating depth cracked, unsecured, or appears to be
structural) unsound
El"Septic/holding Tank #1
Gallons: , s
El Yes o
�—
❑Yes ❑' No
El Yes
peptic/holding Tank #2
,�~
Yes No
Yes
Gallons: ; , a.s�
El Yes ®No
❑
❑ 040
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
E� ump Tank
❑
❑Yes
❑Yes
Gallons
Yes o
�No
❑ No
How Accessed: Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
s ❑ No
+� Yes ❑ No
�1 ,
Did you identify -any, operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
wracked tanks, missing baffles, broken covers, etc.? If so, explain in comments, below.
Tank #1 ❑ Yes ❑ No
Tank #2 ❑ Yes C]�No
Pump Tank El Yes 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: ❑ Land Application: ce-ga-stewater Treatment Plant
Disposal Site:
Lime:
Gallons y �, ,,<� �s �;�
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
W��,� •� , Q� J' �i`'.-.� cam'' ,,,� ��1,r •�
�,.'� �'',,--s�...� ,✓�-� � .sue.
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE i I—'7-1,-2V
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
lick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic9centurylink.net
Pumping Fee.
Name:
v, —�-w
v1
Long Pull Fee:
Address:
Other Repairs:
City/State/Zip:
Total Cost of Servic
`C,,0
Payment Method: ❑ Check ❑ Cash
❑ Credit
Tank leaks above the
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
Tank (check if pre:_. _ the
--
depth
designed operating depth
structural
unsound
2!16eptic/holding Tank #1
_
Gallons:
El Yes F�lT0
El Yes ❑
El Yes
�o
Septic/holding Tank #2
❑ Yes @� No
Gallons: (S—��
El Yes No
❑ Yes
❑ No
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
LAmp Tank
El Yes to
El
'C]
Gallons: �'�
Yes l�No
❑ Yes
No
How Accessed: aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
Ca'Yes ❑ No
es ❑
t
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missina baffles. broken anvers_ etr.7 rf sn_ exniain in rnmmantc 1-1-A/
Tank #1 ❑ Yes o
Tank #2 ❑ Yes No
Pump Tank ❑ Yes o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
4orMound
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevated drainfield
❑ Baffles
❑ Baffles
❑ Baffles
❑ Pressure bed
❑ Non -domestic waste
❑ Non -domestic waste
❑ Electrical issues
❑ Trenches
❑ f Lon -domestic waste
❑ Ponding/Surfacing
Effluent Filter/ creen
❑ Other:
Cleaned? 2'Yes ❑ No
Comments:
Disposal: ❑ Land Application: EMTa`stewater Treatment Plant
Disposal Site:
Lime:
Gallons.] Z� A
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑