HomeMy WebLinkAbout3060 6th Avenue North - Septic Pumping Report - 2026Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 553f7,6
1-DATE V) `2
Maintenance Inspection Form
MP ALic. #L4286
Maintainer Jim
0 Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee: -----
-- - L�
Name:
Long Pull Fee:
Address: IJ
31.E
C
Other Repairs:
City/State/Zip:
Total Cost of Service:
Check El Cash Credit
Tan < ea cs above the aintenance hole cover is damaged,
Tank leaks below t e _T
Tank (check if present)
designed operating depth
cracked, unsecured, or appears to be
designed operating depth
structural) unsound
Septic/holding Tank #1
No
❑ Yes No
❑ Yes E3no
Gallons .
❑ Yes
Septic holding Tank #2
Yes ❑
Gallons:
❑ Yes 15 No
❑ Yes 2No
❑
❑ Pretreatment Tank
G al to q,sz
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
ump Tank
Gallons:
❑ Yes ❑ o
❑Yes No
El Yes "v
How Accessed: aintenance Hole
Scum/Sludge Measured
aintenanncc �es Securely Replaced:
Reason F 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.,
5cked tanks. missing baffles. broken co tc.? Ifso, explain in comments be_s . ,
Tank #1 ❑ Yes inNo
Tank #2 ❑ Yes o
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: A-766? -.ZS 9' a b o
Disposal: ❑ Land Application: astewaterTreatment Plant
Disposal Site:
Lime.
Gallons
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 ❑
,�„- �`'.sue. ,✓- �
Septic Service, LLC
1205 LaBeaux Ave NE
St. Michael, MN 55376
Maintenance Inspection Form
MPCA Lic. #L4286
Maintainer Zjim
= Nick
0 Sam
• Phone: 763-497-2764
• Email: duaneseptic@centurylink.net
INVOICE
Pumping Fee: -----------
-- Ova t
Name:
S30%,
—
Address:��,,.'T'r�Yy�
Long Pull Fee:
Other Repairs:
City/State/Zip:
Total Cost of Service:
Payment Method: ❑ Check ❑ Cash ❑ Credit
Maintenance hole cover is damaged,
Tank (check if present)
Tank leaks below the
Tank leaks above the
cracked, unsecured, or appears to be
designed operating depth
designed operating depth
structurally unsound
❑ Septic/holding Tank #1
El Yes ❑ No
❑Yes ❑ No
El Yes ❑ No
Gallons:
❑ Septic/holding Tank #2
El Yes El No
❑Yes El No
El Yes El No
Gallons:
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
ePump Tank
�--
Gallons: - a�J
❑ Yes ❑,flo'
❑ Yes D-No
❑ Yes 9`l o
How Accessed aintenance Hole
Scum/Sludge Measured
Maintenance Holes Securely Replaced:
Reason For Pumping:
El Other (see attached)
—
ElNo Yes 2
Y❑ es ❑ No
bq-cIG N
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
rrarkerl ranks- missing baffles. broken covers. etc.? If so, exolain in comments below.
Tank #1 ❑ Yes ❑ No
Tank #2 ❑ Yes ❑ No
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: ❑ Land Application: A wastewater Treatment Plant �—lYT-jr +G'y�
Disposal Site:
Lime:
Gallons
Plowed: ❑ Yes ❑ No
Time:
Temperature:
pH: > 12 ❑
Time:
Temperature:
pH: > 12 0
®R WON
= 4 ar VA