Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 5-30-Z <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />lmvntr_l= <br />Pumping Fee: <br />Name: <br />Long Pull Fee: <br />Address: c� <br />SN-e 0 <br />J +�S S-Z <br />1C UV_ <br />Other Repairs: <br />\ <br />City/State/Zip: <br />o_o <br />Total Cost of Servi <br />(� <br />Payment Method: Check ❑ Cash <br />❑ Credit <br />t Vw <br />Tank check if resent <br />( 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 <br />operating depth <br />designed operating depth <br />structural) <br />unsound <br />21"Septic/holding Tank #1 <br />Gallons: I Z � <br />El Yes <br />M o <br />El Yes ❑ No <br />❑ Yes <br />Septic/holding Tank #2 <br />Gallons: l Zip <br />❑Yes <br />oo <br />❑ Yes No <br />❑ Yes <br />_ffT'o <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Pump Tank <br />❑Yes <br />Z <br />Gallons: c�ts-t7 <br />No <br />❑ Yes No <br />❑ Yes <br />e'No <br />How Accessed: Maintenance Hole <br />Scum/Slu e Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />C3'Yes ❑ No <br />Cd'Yes ❑ No <br />111/1e�, t*�-- <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks, missing baffles, broke overs, etc.? Ifso, explain in comments ow. <br />Tank #1 ❑ Yes 0 No <br />Tank #2 ❑ Yes En No <br />Pump Tank ❑ Yes E3No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />2rMound <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 />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ffl"L�yd Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />V1 <br />I Lime: <br />Gallons ? <br />Plowed: <br />❑ Yes <br />ffrNo <br />Time: <br />qY Z <br />Temperature: t `. <br />pH: <br />1 2_2- <br />> 12 E�' <br />Time: <br />Temperature: (4, <br />pH: <br />1 Z - Z <br />> 12 <br />