D6E_Septic_Tank_Maintenance_Report_F_(2).pdf
PDF 165 KB Posted
- Attached to
- D6 East septic tank pumping
- Solicitation number
- 2000016259
- Issued by
- Morrison County, Minnesota
About this file
This document is a Septic Tank Maintenance Reporting Form from the Minnesota Department of Transportation (MnDOT) District 6 East. The form is used to record the details of septic tank maintenance, including the date of maintenance, reason for maintenance, property information, and an assessment of the septic system components. The form requires the maintenance professional to provide information on the access used to remove the septage, the condition of the septic, holding, pretreatment, and pump tanks, and the characteristics of the tanks such as gallons of septage removed, sludge thickness, scum thickness, baffle depth, and baffle length. Additionally, the form asks the maintenance professional to indicate any evidence of non-domestic waste and the disposal site used for the septage. The form concludes with a certification section for the maintenance professional to sign, verifying that they personally conducted the work and made the observations.
This form is used by MnDOT District 6 East to monitor the maintenance of septic systems on state-owned properties. The information collected on this form helps the agency ensure that septic systems are being properly maintained and functioning correctly, which is essential for environmental protection and compliance with state and local regulations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| D6_East_septic_tank_pumping.pdf | ||
| responder_declarations_east_septic.docx | DOCX document | |
| D6E_FY20__Septic_Pumping_Specs_(2).docx | DOCX document | |
| request_for_bid_East_septic.docx | DOCX document | |
| D6E__FY20_Holding_tank_Pumping_Specs_(2).docx | DOCX document | |
| sample_contract_east_septic.docx | DOCX document |
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Text version
Minnesota Department of Transportation
395 John Ireland Boulevard MnDOT District 6 East Saint Paul, MN 55155 2900 48th St NW, Rochester, MN 55901
Septic Tank Maintenance Reporting Form
An Equal Opportunity Employer
Reporting Information
Date of maintenance: Reason for maintenance:
Property address: City: State: Zip:
Property owner’s name:
Site Name:
1. Access used to remove septage: Maintenance hole
2. If maintenance hole was used, were all covers securely replaced? Yes No please explain
Explanation:
3. Is there evidence of tank leakage from a septic, holding, pretreatment or pump tank below the operating depth or evidence of damaged, cracked or structurally unsound maintenance hole covers?
Tank Leaking out Leaking in Cover damage
Septic/holding Tank #1 Yes No Yes No Yes No
Septic/holding Tank #2 Yes No Yes No Yes No
Pretreatment Tank Yes No Yes No Yes No
Pump Tank Yes No Yes No Yes No
4. Characteristics of Tanks (Gallons of septage removed, sludge thickness, scum thickness, baffle depth, baffle length)
Tank #1: Tank #2: Pretreatment Tank: Pump Tank
Gallons removed
Scum thickness
Sludge thickness
Baffle Depth
Baffle Length
Tank Depth
5. Is there any sensory (smell and/or sight) evidence of non-domestic wastes?
Yes No Please explain:
Disposal site: Wastewater treatment plant Land application Other (please explain below)
Explanation:
List any troubleshooting, minor repairs conducted, tank safety* concerns or other concerns:
6. Certification: I hereby certify as a State of Minnesota-certified SSTS Maintainer that I personally conducted the work and made the observations, or directly supervised others in the performance of this job.
Maintainer’s name and address:
Maintainer’s license #: Maintainer’s phone:
Maintainer’s signature: Date:
File details come from the government source that posted it. Updated .