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HomeMy WebLinkAbout775 Lakeview Parkway - Septic Pumping ReportSeptic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE q' "30' 2,.!r Maintenance Inspection Form MPCA Lic. #L4286 Maintainer = Jim *'-Nick 0 Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net 1NVn1rF Pumping Fee. Name: �n Jun Long Pull Fee: Address':(PI © L Lti Ir r Other Repairs: City/State/Zip: Dvov"o Total Cost of Se Payment Method: ❑ Check ❑ Cash ❑ Credit Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be ink leaks below the Tank (check gned operating depth designed operating depth structural) unsound 2 Septic/holding Tank #1 Yes Yes 5 Gallons: t Z5-0 ❑ lZNo ❑ Yes G_1q_0_ ❑ f No Septic/holding Tank #2 ❑ Yes Cn No El Yes ❑ Yes o Gallons: c� .�No U_'t ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 2'0'ump Tank El Yes No El Yes E3 No El Yes 0 No Gallons: L�� I How Accessed: Iff Maintenance Hole Scum/Sludge Measured Maintenance Hales Securely Replaced: Reason For Pumping: ❑ Other (see attached) '❑ No Yes of Yes ❑ No t tiA--� Did you Identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., ,,,-cracked tanks, missing baffles, broken povers, etc.? If so, explain in comment�elow. Tank #1 ❑ Yes in No Tank #2 ❑ Yes No 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: ff'�Vastewater Treatment Plant LJ Disposal Site: Lime: Gallons Z 3 az> Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 ❑ Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE S 1 - -7- -S- Maintenance Inspection Form MPCA Lic. #L4286 Maintainer 0 Jim -Fo Nick = Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net INVOICE Pumping Fee: Name: Long Pull Fee: Address: Other Repairs: City/State/Zip: 1-Vv�_o Total Cost of SE 4C Payment Method: ❑ Check ❑ Cash ❑ Credit o ue Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be 11 ank leaks below the Tank (chec >lgned operating depth designed operating depth structurally unsound Septic/holding Tank #1 Gall ns: t 2 S'"c ❑ Yes 0� ❑ Yes � El Yes �lo— Septic/holding Tank #2 ElYes 'No Gallons: too C ElYes No ❑ Yes 2i.-No ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 9,5rump Tank � El Gallons: 12� Yes ®'No ❑ Yes No ❑ Yes LTl No How Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ElOther (see attached) Comes ❑ No Cd'1'es ❑ No Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., ,.,cracked tanks, missing baffles, brokeryeovers, etc.? If so, explain in comment low. Tank #1 ❑ Yes ONo Tank #2 ❑ Yes RT No Pump Tank ❑ Yes C21NO 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: IT'VVastewater Treatment Plant LJ Disposal Site: Lime: Gallons Z 3 --) Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 0 Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE��- Z� Maintenance Inspection Form MPC�A Lic. #L4286 Maintainer ® JJim 0 Nick 0 Sam • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net imilrWIG Pumping Fee: ;� 5ZIU Name: Long Pull Fee: Address: .-- 317P �� ` _ Vl/.�4 t.:, 76 Other Repairs: City/State/Zip: ,i G' Total Cost of Si Payment Method: ❑ Check ❑ Cash ❑ Credit Tank (checl ank leaks below the Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be igned operating depth designed operating depth structural) unsound Septic/holding Tank #1 Gallons: El Yes E. ^! El Yes ❑ Yes • t7 No Septic/holding Tank #2 Gallons: ❑ Yes No ❑ Yes _P_<0 ❑ Yes C-No ❑ Pretreatment Tank Gallo ElYes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Pump Tank ,� ❑ Yes No El ,/ Gallons: -e Yes No El Yes _,rNo i How AccessedO Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: El Other (see attached) / El Yes r- No -0'Yes ❑ No Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system, i.e., wed tanks, missing baffles, broken cars, etc.? Ifso, explain in comments below. Tank #1 ❑ Yes gq4o Tank #2 ❑ Yes o Pump Tank ❑ Yes o System . ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity Efr 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: ❑ Wastewater Treatment Plant Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No Time: : ;; Temperature: — pH: >,12 ❑ Time: Temperature: 1 • pH: > 12 ❑ PIP r/A V _j � .sue- ,✓'`�'� �' .sue