Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 1 _— 7 )-l� <br />Pumoinq Feej <br />u <br />Maintenance Inspection Form <br />7s, <br />Lic. #L4286 <br />Maintainer <br />Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Name: <br />Address: <br />utner mepalrs: <br />V�iyrJtd�efL1f' <br />o <br />4&__ <br />ku <br />__6;�3Do� , <br />Payment Method: ❑ Check ❑ Cash redit <br />Total Cost of Ss <br />37(�'7 � 3C) 5­9T <br />?3ooa <br />Maintenance hole cover is damaged, <br />Tank (check <br />,nk leaks below the <br />Tank leaks above the <br />cracked, unsecured, or appears to be <br />esigned operating depth <br />designed operating depth <br />structural) unsound <br />tn'&ptic/holding Tank #1 <br />❑ No <br />El Yes o <br />Gallo <br />El Yes �o <br />❑Yes <br />Septic/holding Tank #2 <br />❑ Yes e No <br />❑ Yes !Flap <br />❑ Yes ❑� <br />Gallons: <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallon <br />Pump Tank <br />❑ Yes 2 No <br />❑ Yes o <br />❑ Yes No <br />Gallons: <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: Reason For Pumpin <br />e, b,-jl <br />❑ Other (see attached) <br />❑ Yes iffr No <br />es ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks In thissstem, i.e., <br />Tank #1 ❑ Yes ZL.DK <br />Tank #2 ❑ Yes No <br />Pump Tank ❑Yes No <br />System <br />❑ Structural integrity <br />ElStructural integrity <br />❑ Structural integrity <br />ound <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: -Land Application: ❑ Wastewater Treatment Plant <br />Dis osal Site: Lime: f Gallons = Plowed: El Yes D-No <br />P <br />Time: ; Temperature: pH: > 12 -❑. <br />Time: Temperature: pH: > 12 ❑ <br />a► • <br />`. ..� <br />�,�,� �✓_` �--.sue- -�'''..�. ,✓'-'�-,. �.�✓" .sue <br />