HomeMy WebLinkAbout1290 Orono Oaks Drive - Septic Pumping ReportSeptic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
r%ATC C—_ 1 1, , 7 Sl
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
4TNick
= Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping FPp• ►
Name: 'FUi
Address:
t Z cl 0
Long Pull F
�
City/State/Zip:
Other Repc
V-0iD
Total Cost 1
, mar (�
Payment Method: ❑ Check ❑ Cash
❑ Credit
ti d4
Maintenance hole cover is damaged,
Tank (check if presen
ank leaks below the
designed operating depth
Tank leaks above the
designed operating depth
cracked, unsecured, or appears to be
structurally
unsound
Q eptic/holding Tank #1
❑ Yes 0-5-0—
❑ Yes
P—No
❑ Yes
0 to
G al-aJ lons:Lp
Ca'Sll�eptic/holding Tank #2
El Yes C�" No
El Yes
C %
❑Yes
E� No
Gallons: Lc—9 ,
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Gallons:
Pump Tank
ElYes
L;1
Gallons: � e �
❑ Yes Q40
El Yes
No
-low Accessed: E3Maintenance Hole
Scum/Sludge Measured
oles Securely Replaced:
MaintenVes
Reason For Pumping:
El Other (see attached)
� Yes El No
❑ No
VW Ca.4 w
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
k,An ,, k , L—, oKi. ofr 7 rr cn arnlain in rnmmenf3 below.
Tank #1 ❑ Yes ffNo
Tank #2 ❑ Yes No
Pump Tank ❑ Yes 2TNo
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: E5 Land Application: ❑ Wastewater Treatment Plant
disposal Site: �^� t Lime: Gallons 2- �.a Plowed: El Yes ON
time: Temperature: 1N t 3�t pH: t Z_C( > 12
rime: 2 3 7 Temperature: 'Z'am ° L 3 pH: l2 > 12
s�-
Jim Eicher
D
Septic 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
..... _V
Pumping Fee:
Name: 3
Long Pull Fee:
Address:
l ! oS
e th,ys �r -
Other Repairs: \ -,
t` GS V L Z L LcJ r�
City/State/Zip:
U-19 t/�-o
Total Cost of Service: -
- -
�wV_
Payment Method: ❑ Check El Cash ❑ Credit
Maintenance hole cover is damaged,
Tank (check if prese
T eaks below the
designed operating depth
Tank leaks above the
designed operating depth
cracked, unsecured, or appears to be
structural) unsound
[I"Septic/holding Tank #1
❑Yes No
El Yes �o
El Yes �o
Gallons: (2s�
Septic/holding Tank #2
❑ Yes Z No
❑ Yes p No
❑ Yes Z No
Gallons: l 2S-'
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
C--(Pump Tank
/
❑ Yes 4!5 No
❑ Yes D No
❑ Yes of No
Gallons:
How Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
❑ Other (see attached) 1I Yes ❑ No Zf Yes ❑ No /VLG L''f
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
__ ti.,.1.,.., a atr 7 Tf — avnlaln in rnmments,below.
Tank #1 ❑ Yes o
Tank #2 ❑ Yes No
Pump Tank El No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
❑ Risers leaking
En Mound
❑ Elevated drainfield
❑ Risers leaking
❑ Baffles
❑ Risers leaking
❑ Baffles
❑ Baffles
❑ Pressure bed
❑ Non -domestic waste
❑ Non -domestic waste
❑ Electrical issues
❑ Non -domestic waste
❑ Trenches
❑ Ponding/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments: Sr. �o F Lis L Cc �e
w Ke �- S 4 c� G l
ervvw ti
w �� k �,►,, o v c�ttis� dl.�, t�..-��,c. ...1-a sY s ��'• _
nisnnsal: ❑ Land Aoolication: r_1 Wastewater I reatment runt w
Disposal Site:
Lime:
Gallons2 (0.c.,-0
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
> 12 ❑
Time:
Temperature:
pH:
> 12 0
DVANE*�
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
nerI: S-' S- Z.'5'
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
Nick
Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee:
Name:
V
Address: 4 L( S S
Long Pull Fee:
Other Repairs:
City/State/Zip:
�V-0V'_D
Total Cost of Sei
-� L
Payment Method: ❑ Check ❑ Cash
❑ Credit
aw
0H
Tank leaks above the
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
nk leaks below the
Tank (check
fined operating depth
designed operating depth
structural)
unsound
Septic/holding Tank #1
El Yes No
El Yes Cl No
El Yes
2-6-0
Gallons: (3 iT�
Septic/holding Tank #2
❑ 'No Yes C�
❑Yes C1 No
El Yes
No
Gallons: t 5
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
Pump Tank
❑ Yes C" No
❑ Yes Z No
❑ Yes
Z No
Gallons: r 0-0
How Accessed: Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
El Other (see attached)
PlYes ❑ No
I -I es ❑ No
'.�
Did you identiy(��� any operational issues or unsafe condltions while assessing the sewage tanks in this system, i.e.,
/_—&—i tin Le ,« ., r,arfroc hr Lron �nvarc etr_ 7 ff sn. explain in commentsi166elow.
Tank #1 ❑ Yes En No
Tank #2 ❑ Yes No
Pump Tank ❑ Yes E^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 W
Disposal Site:
Lime:
Gallons 2'7 60
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
> 12 ❑
Time:
Temperature:
pH:
> 12 0
I .— ME:- 0,61 ON, w; mm, - — W-1-oo 01 1
Jim Eicher
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 5- Z0, _-S'
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
4rNick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee:
Name: p t�1. S -f-T
1
� '
Long Pull Fee:
t
Address:
Other Repairs:
City/State/Zip:
Total Cost of SeR
71
Payment Method: El Check El Cash
Y
El Credit
`o�
Tank leaks above the
Maintenance hole cover is damaged,
cracked, unsecured, or appears to be
k leaks below the
Tank (check if
ied operating depth
designed operating depth
structural) unsound
�tic/holding Tank #1
Yes
--
❑ No
t Z Sp
3—No—
❑ Yes C
El Yes No
El
Septic/holding Tank #2
❑ Yes d No
El Yes C�No
El Yes
n No
Gallons: � Lsro
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
Pump Tank
❑ Yes V, No
❑ Yes Ei'No
❑ Yes
_iJo
Gallons: c Zgb
How Accessed: PVaintenance Hole
Scum/Sludge Measured
Maintenance Hales Securely Replaced:
Reason For Pumping:
❑ Other (see attached) I
121" es ❑ No
9-Y-e-ss ❑ No
�� t
Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e.,
.-*'cracked tanks, missing baffles, broken-c-overs, etc.? If so, explainfn comments below.
Tank #1 ❑ Yes No
Tank #2 ❑ Yes No
Pump Tank es ❑ 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
❑ �en-domestic waste
❑ Ponding/Surfacing
Effluent Filte�4screen
❑ Other:
Cleaned? CirYes ❑ No
Comments: �� + ` �� �� S P ✓ �JI -5=� I I �sL �w } J_
Disposal: ❑ Land Application: Er/Wastewater Treatment Plant LO 4' + %j ''
Disposal Site:
Lime:
Gallons 2 -7
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 0
VAIV
V__ '_ 90
D�VANE
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
1'1ATL' It_ ) t" - 7_
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer 0 Jim
Nick
= Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumnino Fee: d , , , , _
Name:
Address:
t'( -j C)
►;-w wt >r v .
City/State/Zip:
Payment Method: eck ❑ Ca
Credit
Maintenance hol
over is damaged,
Tank (check if present)
Tank leaks below the
Tank leaks a ve the
th
cracked, u ured, or appears to be
designed operating depth
designed operatin
structural)
unsound
❑'Septic/holding Tank #1
❑ Yes
No
❑ Yes D-tgo
❑ Yes
D-<O
Gallons:'7,5--^
09'eptic/holding Tank #2
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes
❑ No
Gallons:
Pretreatment Tank
❑ Yes
ET -No❑
Yes Jo
ElYes
Gallons: -f,�
Gump Tank
❑ Yes
Q No
❑ Yes
El No
El Yes B No
Gallons: �
-low Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping:
El Other El (see attached) [1 No C Yes ❑ No I v,VLC '-
Did you identify any operational issues or unsafe conditions while assessing the sewage tan�kss in this system, i.e.,
11-., Apia-_ ;—t—, -. is aFr 7 rf Cn_-Ynlgin in rnmment�elow.
Tank #1 ❑ Yes n No
Tank #2 ❑ Yes n No
Pump Tank ❑ Yes No
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
Mound
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevated drainfield
❑ Baffles
❑ Baffles
10 Baffles
❑ Pressure bed
❑ Non -domestic waste
❑ Non -domestic waste
❑ Electrical issues
❑ Non -domestic waste
❑ Trenches
❑ Ponding/Surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑rYes ❑ No
Comments: �o 1 w.�e
r„
Disoosal: ❑ Land Application: QWastewater Treatment Plant a ---
disposal Site:
Lime:
Gallons a Z 5',?
Plowed: ❑ Yes
❑ No
Time:
Temperature:
pH:
> 12 ❑
rime:
Temperature:
pH:
> 12 ❑
�""6 '�.-•.t
�..•�- �.�-s� -�---� ,,.�-'�-•. �`'� sue.