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HomeMy WebLinkAbout870 Old Crystal Bay Road South - Septic Pumping ReportSeptic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 Maintenance Inspection Form MPCA Lic. #L4286 Maintainer Jim Nick 0 Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE LJMI L Pumping Fee: Name: - Address: Long Pull Fee: Other Repairs: City/State/Zip: 0 V-00 -o Total Cost of SE Payment Method: ❑ Check ❑ Cash ❑ Credit VOL", Maintenance hole cover is damaged, Tank (check ink leaks below the gned operating depth Tank leaks above the designed operating depth cracked, unsecured, or appears to be structural) unsound Septic/holding Tank #1 ❑ Yes E No ❑ Yes No ❑ Yes Gallons: ( 2Z3'0 ET-Septic/holding Tank #2 ❑ Yes n No ❑ Yes Ql<o ❑ Yes Z NO Gallons: ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: 2/pump Tank El Yes Z No El Yes 2--No El Yes ,� [7" No Gallons: p J How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) UT -Yes ❑ No Q Yes El No Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks In th/s system, i.e., _..11-- or, 7 Tr — a 1n in in rnmmPn N_hPlnw. Tank #1 ❑ Yes No Tank #2 ❑ Yes 2No Pump Tank ❑ Yes No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ound ❑ Elevated drainfield ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Pressure bed ❑ Baffles ❑ Non -domestic waste ❑ Baffles ❑ Non -domestic waste ❑ Baffles ❑ Electrical issues ❑ Trenches ❑ Non -domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: ❑ Land Application: [?,Wastewater Treatment riant L rK- � � -- Disposal Site: Lime: Gallons 3 6? Plowed: ❑ Yes ❑ No Time: Temperature: pH: E]EE 2 ❑Time: Temperature: pH: 2 ❑ Jim Eicher D Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 °1_1 1 - 7 < Maintenance Inspection Form MPCA Lic. #L4286 Maintainer Jim -Nick Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE Lim I G Pumping FE Name: t S • k� Long Pull F Address: �.-7 D Other Repa City/State/Zip: Total Cost c Ci v� Payment Method: ❑ Check ❑ Cash ❑ Credit Tank leaks above the designed operating depth Maintenance hole cover is damaged, cracked, unsecured, or appears to be structural) unsound Tank leaks below the Tank (c designed operating depth eptic/holding Tank #1 Gallons: �g,� eptic/holding Tank #2 Gallons: ( o 9✓� El Yes ❑ El Yes C�' No El Yes �o ❑Yes l� No El Yes No El No ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ump Tank Gallons: LQoo ❑Yes VIVO ❑Yes No _/ ❑Yes -LI No How Accessed: ❑ Maintenance Hole ❑ Other (see attached) Scum/Sludge Measured fl Yes ElNo Maintenance Holes Securely Replaced: es ❑ No Reason For Pumping: �t-`�-�� �4- Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., racked tanks, missing baffles, broken c vers, etc.? If so, explain in comment elow. #1 ❑ Yes No I Tank #2 ❑ Yes o Pump Tank ❑ Yes C No Syste ❑ Structural integrity Mound ❑ Structural integrity ❑ Risers leaking ❑ Structural integrity ❑ Risers leaking ❑ Risers leaking El Elevated drainfield ❑ Baffles ❑ Baffles ❑Baffles ❑ Pressure bed [I Trenches ❑ Non -domestic waste El Non -domestic waste ElElectrical issues ❑ Non -domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: cleaned? ❑ Yes ❑ No Comments: -(`� �jr� C�u�e-S J'Z A s��« Disposal: ❑ Land Application: i�astewater Treatment Plant\-�'K''_ Disposal Site: Lime: Gallons -2w Plowed Time: Temperature: pH: Time: Temperature: pH: "r &_- ❑ Yes ❑ No >12 ❑ >12 ❑ DV�E� Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 n nr= '?_ , I — Z J� Maintenance Inspection Form MPCA Lic. #L4286 Maintainer Jim Nick fti Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE Pumping FeE Name: Address:,Z —4-)48e� Long Pull Fe, Other Repair City/State/Zip: Payment Method: ElCheck ElCash ElCredit Total Cost of "�4,, V ok Tank (check if present) ----Tank- leaks 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 Septic/holding Tank #1 '�b El Yes C.I-No El Yes No El Yes 4❑ No Gallons: 1 5v ET'S'eptic/holding Tank #2 040 ❑ Yes N❑ o Gallons: ❑ Yes Cf No ❑ Yes ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: Eff1pump Tank ❑ Yes No El Yes No El Yes Gallons: t 500 How Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: El Other (see attached) 2'Yes El No El Yes ❑ No iL'_ �_� Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., ..�...a — i. ...;. ; ., F—m— h. L. n .- 1— otr 7 rf cneynlaln in rnmmpnt--flelow. Tank #1 ❑ Yes RT No Tank #2 ❑ Yes No Pump Tank ❑ 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: EMastewater Treatment Plant, � Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 ❑ ��--�-�- �`'� sue. ,✓�-'� �`'" .s�- Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE %- ( (— 2-r Maintenance Inspection (Form MPCA Lic. #L4286 Maintainer Jim ANick 0 Sam hone: 763-497-2764 ® Email: duaneseptic@centurylink.net MAIrUrrG Pumping FeP• Name: S0G� Long Pull Fe Address: -6 U S Other Repair City/State/Zip: 0� a Total Cost of Payment Method: ❑ Check ❑ Cash ❑ Credit Tank (check if present) Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be designed operating depth designed operating depth structurally unsound ErS'eptic/holding Tank #1 Gallons: f-7s--p ❑ Yes RrITO ❑ Yes � ❑ Yes ❑�oN 12'9_e­ptic/holding Tank #2 / El Yes fl Yes ff -No Yes l Gallons: o No ❑ E ❑ ❑ No ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑'6ump Tank Gallons: t 2�� El Yes ❑40 El Yes No El Yes ❑ No How Accessed: OQaintenance Hole ge Measured ScumVes Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) ❑'❑ No C3'Yes ❑ No Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., _,eracked tanks, missing baffles, broken_eovers, etc.? Ifso, explain in comments -below. Tank #1 ❑ Yes KNo Tank #2 ❑ Yes El No Pump Tank ❑ Yes ONo 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 Cl Non -domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: PfLand Application: F/astewater Treatment Plant Disposal Site: Z Lime: I---- Gallons 2_�Vo Plowed: ❑ Yes --E!rN—o Time: a30 Temperature: (qi 'o pH: L > 12 El — Time: yJ c) Temperature: pH: z; Z > 12 0 Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE -7- t Y- 2-5- Maintenance Inspection Form MPCA Lic. #L4286 Maintainer 0 Jim [lick 0 Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE Pumping Fe Name: E. I�wt J Long Pull Fi Address: (.�- ? Z � City/State/Zip: Other Repa c �y �-2- Total Cost ck� Payment Method: El Check ❑ Cash ❑ Credit Tank (check if presen Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be designed operating depth designed operating depth structurally unsound Septic/holding Tank #1 ❑ Yes 1:111W ❑ Yes 0•1q_0_ ❑ Yes Colo Gallons:L9-->-O Septic/holding Tank #2 ❑ Yes No ❑ Yes 0-N-o ❑ Yes Foo Gallons: L J.Jv ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 13*9'ump Tank ❑ Yes No ❑ Yes No ❑ Yes Gallons: tbib C, How Accessed: Maintenance Hole Scum/Sludge Measured Maintenann 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., acked tanks, missing baffles, broken covers, etc.? If so, explain in comments W. ,pr Tank #1 ❑ Yes o Tank #2 ❑ Yes o 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: and Application: ❑ Wastewater Treatment Plant Disposal Site: ti Lime: Gallons ?,1 ) Plowed: ❑ Yes No Time: fo3g Temperature: Z 1, Y pH: I Z,_ t > 12 Ell Time: Temperature: Z Z-L pH: ( Z._ ( > 12 R-5 a ILI oil '44 "M IW47