Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nATEQ-Z2—Z-Z.• <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer = Jim <br />Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: $ <br />Scum/Sludge Measured <br />Name: <br />Reason For Pumping: <br />❑ Other (see attached) <br />El Yes CXNo <br />L G � �% ` Gam✓ <br />ff VV-' � <br />O Risers leaking <br />� i' 4� <br />1 <br />❑ Elevated dralnfield <br />❑ Baffles <br />Long Pull Fee: <br />EI Baffles <br />❑ Pressure bed <br />Address: <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />Other Repairs: <br />City/State0p: <br />Comments; <br />Total Cost of Service: <br />lei <br />Payment Method: <br />Check ❑ Cash <br />4 <br />El Credit <br />7 <br />y &D <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />designed operating <br />depth <br />designed operating <br />depth <br />structurally <br />unsound <br />tic/holding Tank #1 <br />Gallons: (,)9LR) <br />❑ Yes <br />ffNgo _ <br />❑ Yes <br />e -K-0 <br />❑ Yes <br />t5 No <br />C�Septic/holding Tank #2 <br />d No <br />❑Yes <br />C3-Klo_ <br />Gallons: l�J <br />❑Yes'Co <br />❑Yes <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />lump Tank <br />No <br />11Yes <br />Gallons: yD&�) <br />❑ Yes <br />ff No <br />❑ Yes <br />How Accessed; aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />El Yes CXNo <br />Yes ❑ No <br />ff VV-' � <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I. e,, <br />cracked tanks, missina baffles, broken covers, etc.? If so, exDlain In comments_be4ow. <br />Tank #1 ❑ Yes p4lqo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes EYN o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ffWound <br />O Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated dralnfield <br />❑ Baffles <br />❑ Baffles <br />EI Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments; <br />Disposal: ❑ Land Application: wastewater Treatment Plant Lv`4&4,-A <br />Disposal Site: Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />>12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />gum <br />OA -11 <br />