HomeMy WebLinkAbout640 Orchard Park Road - Septic Pumping Report - 2026Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
DATE 5-_y �LCt
Maintenance Inspection Form
MP Lic. #L4286
Maintainer Jim
0 Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
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Pumping Fee:
Name:
Long Pull Fee:
10.
Address:
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6rcl..c4-
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Other Repairs:
City/State/Zip:
Total Cost of Ser
Payment Method: ❑ Check ❑ Cash ❑ Credit
elow the
Tank leaks above the
Maintenance hole cover is damaged,
Tank (check ii
uG�iyi iCu operating depth
designed operating depth
cracked, unsecured, or appears to be
structural) unsound
Septic/holding Tank #1
�
-r No
�
Yes No
Gallons: I Duo
El Yes �J No
❑ Yes
❑
Z'Septic/holding Tank #2
❑ Yes Z No
Gallons: 10,0
❑ Yes Fl No
❑ Yes If No
❑ Pretreatment Tank
Gallons:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Pump Tank
"No
�21'
Gallons:
ElYes
❑ Yes No
❑ Yes No
VA
How Accessed:ln Maintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
❑ Other (see attached)
❑ Yes NCB" o
es ❑ No
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Did you identify��nny operational issues or unsafe condition .while assessing the sewage tanks in this system, i.e.,
�CFacked tanks, missino baffles, broken c rs, etc.? If so, explain in comments bf4eTv.
Tank #1 ❑ Yes ZNo
Tank #2 ❑ Yes o
Pump Tank ❑ Yes o
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
EIMound
❑ 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: !!!!�W_astewaterTreatment Plant �,� j y,'j�L-�
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
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