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HomeMy WebLinkAbout980 Cox Farm Road - Septic Pumping ReportSeptic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE 7 1 I(- z S Pumping Fee: Long Pull Fee: Other Repairs: Total Cost of Servi, Maintenance Inspection Form MPCA Lic. #L4286 Maintainer Jim Nick = Sam • Phone: 763-497-2764 • Email: duanesepticCcenturylink.net INVOICE Name:,�`�� ai© ek �lLuC, Address: City/State/Zip: Uo,w Payment Method: ❑ Check ❑ Cash ❑ Credit y� Maintenance hole cover is damaged, -aks below the Tank leaks above the cracked, unsecured, or appears to be Tank (check if pr gned operating depth designed operating depth � structural) unsound eptic/holding Tank #1 ❑ Yes No ❑ Yes CfiNo ❑ Yes No Gallons: ( ❑ Septic/holding Tank #2 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: ❑ Pump Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: How Accessed: aintenance Hole Scum/Sludge Meas�ur d Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) ❑Yes ❑ No C� Yes ❑ No �"` �� Did you identify any operational issues or unsafe conditions whiie assessing the sewage tanks in this system, i.e., cked tanks, missing baffles, broken covers, etc.? If so, explain in comments below. Tank #1 ❑ Yes o Tank #2 ❑ Yes ❑ No Pump Tank ❑ Yes ❑ No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ❑ Mound El Risers leaking g ❑ Risers leaking ElRisers leaking ❑ Elevated drainfield ❑ Baffles ❑Baffles El Baffles ❑ Pressure bed ❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches ❑ Non -domestic waste ❑ Ping/Surfacing ❑ Effluent Filter/screen Er9t er f� Cleaned? ❑ Yes ❑ No Comments: n �, r v .�— kt N Disposal: C�Land Application: ❑Wastewater Treatment Plant Disposal Site: �� Lime: Gallons 1� Plowed: El Yes No Temperature: q,'? pH: iZ- Z- > 12 � Time: 3 D 3 L > 12 Time: 3Y Temperature: -2_Q. y pH: 2' a O -f ► Jim Eicher Maintenance Inspection Form MP Lic. #L4286 Maintainer Jim Nick p 0 Sam Septic Service, LLC • Phone: 763-497-2764 1205 LaBeaux Ave NE St. Michael, MN 55376 •Email: duaneseptic@centurylink.net DATE -1"_I6-2� INVOICE Pumping Fee: Name: M d j z h f Ut A Long Pull Fee: Address: Other Repairs: l City/State/Zip: Total Cost of Ser ❑ Check ❑ Cash Credit Maintenance hole cover is damaged, ik leaks below the the cracked, unsecured, or appears to be Ta k (check i ned operating depth designed operating depth structural) unsound Septic/holdin Tank #1 ❑ Yes No ❑ Yes ❑ Yes No Gallons:tvvjl 2'gelpfic/holdin Tank #2 ❑ Yes gr-No— ❑ Yes elNo ❑ Yes ' No Gallons: OW ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: �ump Tank ❑ Yes Fei o JO; El Yes 4�1 No ❑ Yes No Gallons: luvo How Accessed: aintenance Hole Scum/Sludge Measureed Maintenance Holes Securely Replaced: Reason For Pumping: El Other (see attached) El Yes Cl'No ®"des ❑ No Did you identify operational issues or unsafe conditions while assessing the sewage tanks in this system, i_e., acked tanks, missing baffles, broken c s, etc.? If so, explain in comments be Tank #1 ❑ Yes o Tank #2 ❑Yes o Pump Tank ❑ Yes ❑ 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 Disposal: ; O--Land Application: ❑ Wastewater Treatment Plant Disposal Site: 1 , { Lime: J Gallons - Plowed: ❑ Yes El No Temperature: pH: > 12 ❑ Time: Time: Temperature: pH: > 12 El Jim Eicher D Septic Service, LLC 1205 LaBeaux Ave NE St. Michael,MN 55376 ^ M w9rF- /_ I --1 '7 Maintenance Inspection Form MPCA Lic. #L4286 Maintainer 0 Jim Nick Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE Pumping Fee: Name: ti 4'\ CA, Address: ZS, -1-�kc.�> 5 lam' �l Long Pull Fee: Other Repairs: City/State/Zip: � ivy Total Cost of Ser Payment Method: ❑ Check ❑ Cash ❑ Credit o.. Maintenance hole cover is damaged, Tank (check i ik leaks below the Tank leaks above the cracked, unsecured, or appears to be ned operating depth designed operating depth structural) unsound Septic/holding Tank #1 ❑ Yes Er-K-0 ❑ Yes 77No ❑ Yes ET- 'No Gallons: tooc) Septic/holding Tank #2 El Yes No El Yes L� No ❑Yes Gallons: v-� ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: ETIP"ump Tank El No El Z No ElYes ��10 Gallons: (,�� -iow Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: El Other (see attached) El Yes � Nuro 0 Yes ❑ No V�L,. �'r Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., t,. I ra ­ in i-nm tc hainw_ Tank #1 ❑ Yes EYNo Tank #2 ❑ Yes o Pump Tank ❑ Yes Z NomPonding/Surfacing ❑ Structural integrity ❑ Risers leaking ❑ Structural integrity ❑ Risers leaking ❑ Structural integrity ❑ Risers leaking infield ❑ Baffles ❑ Non -domestic waste ❑ Baffles ❑ Non -domestic waste ❑ Baffles ❑ Electrical issues ❑ Non -domestic waste facing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments:T��w c��� kA- ?L'V' leIC5 GQ©vet 40 4., K 4 Disposal: SLand Application: ❑ Wastewater Treatment Plant - Disposal Site: �`Z- Lime: Gallons a Plowed: El Yes C�' Time: OCI Temperature: t �• pH: (L_ Z > 12 Time: `3' $ Temperature: Z0-0 pH: iZ-Z. >12 •�:.�, �.sr� �-�� ....�---� �•-'��, ✓" sue. Jim Eicher D Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 t0 o f Maintenance Inspection Form MPCA Lic. #L4286 Maintainer 0 Jim lick = Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net Pumping Fee: Name: V Address: Long Pull Fee: City/State/Zip: Other Repairs: U 0 "-o Total Cost of Se I Payment Method: ❑ Check ❑ Cash ❑ Credit u dw Maintenance hole cover is damaged, Tank (check if eaks below the Tank leaks above the cracked, unsecured, or appears to be operating depth designed operating depth structurally unsound Septic/holding Tank #1 ❑ Yes No ❑ Yes No ❑ Yes 2-I10 Gallons: l Z I�tic/holding Tank #2 21"No ❑ Yes Gallons: (0.0-0 ❑ Yes No ❑ Yes ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: ump Tank ❑ Yes Zo ❑ Yes No ❑ Yes 1:;�o Gallons: 1 CF-vV 1-1 How Accessed: Maintenance Hole Scum/%SI dge Measured Maintenance Holes Securely Replaced: Reason For Pumping: El Other (see attached) fl Yes ❑ No es El No �...�— Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., otr 7 Tf cn arnlain in comments below. Tank #1 ❑ Yes 15 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 2T-1,53 Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 0 Jim Eicher D a Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 —r_-)ter --7e" Maintenance Inspection Form MPCA Lic. #L4286 Maintainer 0 Jim Nick Sam • Phone: 763-497-2764 �! • Email: duaneseptic@centurylink.net INVOICE Pumping Fee: Name: -� Address: PKv Lon Pull Fee: i 9 Other Repairs: City/State/Zip: 1 (iu -p J—o '-7L/ kja Total Cost of Se ice ti k Payment Method: ❑ Check ❑ Cash ❑ Credit Maintenance hole cover is damaged, Tank (check if present Tank leaks below the designed operating depth Tank leaks above the designed operating depth cracked, unsecured, or appears to be structural) unsound �ptic/holding Tank #1 ❑ Yes 31 o ❑ Yes ❑ Yes B—t�to Gallons: l 2-5-0 peptic/holding Tank #2 El Yes XNo El Yes 1�0 El Yes Gallons: �,9� ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: imp Tank ❑ Yes C? No ❑ Yes 0' No ❑ Yes Gallons: t ZrO How Accessed: Elf0ainteriance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) es ❑ No B'Yes ❑ No Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system, i.e., .. �._.,i,,... aP, J rf cm avnlain in rnmmL..ntS below. Tank #1 ❑Yes o Tank #2 ❑Yes No Pump Tank ❑ Yes No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ❑ Risers leaking ound ❑ Elevated drainfield ❑ Risers leaking ❑ Risers leaking ❑ Baffles ❑ Pressure bed ❑ Baffles ❑ Non -domestic waste ❑ Baffles ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches ❑ Non -domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: ❑ Land Application: ❑ Wastewater Treatment riani Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 ❑ G o THANKS! a �� G Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 nerF --2V-7_� Maintenance Inspection Form MPCA Lic. #L4286 Maintainer Jim P ick =am • Phone: 763-497-2764 • Email: duaneseptic9centurylink.net INVOICE Pumping Fee: _ Name: b VcjA , Long Pull Fee: ( Address: City/State/Zip: Other Repairs: Total Cost of Servi V Payment Method: El Check El Cash El Credit c Tank (chek i t 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 Gallons: �2 ❑ Yes ❑-1115— ❑ Yes Et o ❑ Yes Flo Septic/holding Tank #2 El Yes f1'No El Yes ❑ No El Yes n'� Gallons: � �9-� ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Gallons: Pump Tank ❑ Yes ❑ No ❑ Yes No El Yes 2-IN o Gallons: l Z�' How Accessed: aintenance Hole [_�_�ff_Y_e's ce Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) ❑ No files ❑ No f!��-��^- Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., a F L­ ,;« , h,rRm, hr Le r /Pm al'r 7 Tf an_ exnlain in cnmments below. Tank #1 ❑ Yes No Tank #2 ❑ Yes ❑ o Pump Tank ❑ Yes No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity nMound ❑ 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'Uastewater Treatment Plant Disposal Site: Lime: Gallons 2 &--o Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 ❑ IN,