Laserfiche WebLink
icher <br /> Maintenance Inspection Form <br /> MPC Lic. #L4286 <br /> Maintainer Jim <br /> ❑ Nick <br /> Service, LLC <br /> Beaux Ave NE • Phone: 763-497-2764 <br /> ifael, MN 55376 • Email: duaneseptic@centurylink.net <br /> 5-/'Z`-( INVOICE <br /> j Fee: 4 L/� 1 5U Name: Pot ce_i›i-cL 8 GiA c:t1 <br /> III Fee: Address: <br /> l 0 Trv-r o� Tri <br /> epairs: City/State/Zip: <br /> L._.°kt) LLti—e--- <br /> st of Service• �� Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, <br /> lk(check if present) designed operating depth designed operating depth cracked,unsecured,or appears to be <br /> structurally unsound <br />'holding Tank#1 <br /> 5� 0 Yes .� N o 7�N No❑ Yes ' o ❑ Yes If <br />'holding Tank#2 <br /> / ❑ Yes P4 ❑ Yes .2 No ❑ Yes �'No <br /> Itment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Tank <br /> sat, ❑ Yes fC1.-110 D Yes No ❑ Yes 124o <br /> 3ssed:e Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For P roping: <br /> ❑Other(see attached) ❑ Yes lL1.-tQo -0'Yes ❑ No , <br /> Did you identify an operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br /> ed tanks, missing baffles, broken c - etc.?If so, explain in comments belo ' <br /> ❑ Yes No Tank#2 ❑ Yes No Pump Tank ❑ Yes o System / <br /> Itructural integrity ❑ Structural integrity ❑ Structural integrity re-Mound <br /> users leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> iaffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> Jon-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑ Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes ❑ No <br /> ts: <br /> Disposal: ❑ Land Application: 1 Wastewater Treatment Plant '�A,.�„� (Jw•,'\._ <br /> Site: Lime: Gallons Plowed: 0 Yes ❑ No <br /> Temperature: pH: >12 ❑ <br /> Temperature: pH: >12 ❑ <br /> 0.141D THANKS! „owear <br /> sue. ,..� .s`'r sue• <br />