Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 5537,/6 <br />DATE �- 15?- Z`l <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Name: <br />INVVlUr- <br />7.� <br />V_00 as <br />Long Pull Fee: <br />Address: <br />/ <br />Other Repairs: <br />City/State/Zip: <br />0 V-aV�o <br />Total Cost of Se <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank eck if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Septic/holding Tank #1 <br />Gallons: <br />ElYes <br />iZi No <br />❑ Yes <br />ElYes <br />O/Septic/holding Tank #2 <br />��� <br />Gallons; �;;� <br />❑Yes <br />Clo <br />❑ Yes l� No <br />❑ Yes <br />C7 No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Pump Tank <br />Gallons: f S- <br />❑ Yes <br />—/ <br />12' No <br />/ <br />❑ Yes INo <br />❑ Yes <br />No <br />Accessed: Maintenance Hole <br />❑ Other <br />Scum//Sludge Measured <br />Maintenance Holes Securely Replaced: <br />;;Yes <br />Reason For Pumping: <br />(see attached) <br />11Yes ❑ No <br />❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />,cracked tanks. missino haffles. hrnkan rnvarc arms 7 rf cn v mr ten. _ _ 1-1-,., <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes o <br />Pump Tank Yes ❑ No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />171 Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non -domestic waste <br />❑ Non -domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑domestic w ste <br />❑ Ponding/Surfacing <br />11 Effluent Filte creep <br />❑Other: <br />Cleaned? Yes ❑ No <br />Comments: �~ 1 IrCr 1,.,�5 ��� c�l� �r✓.`,ro„� _ `�D� S'L�-1 C -eA- <br />� I <br />Y s1,��� �„�1 ����y Ott_ Lc CA tss rc© �+v��_ { . <br />Disposal: ©-Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: V 1 <br />Lime: <br />Gallons <br />Plowed: <br />❑ Yes ❑ o <br />Time: <br />ZIP <br />Temperature: <br />P �5• � <br />pH: <br />12'_2 >12 <br />Time: <br />12 Y I <br />Temperature: <br />P H; <br />[7•2 > 12 <br />