Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nerF --2V-7_� <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />P <br />ick <br />=am <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />INVOICE <br />Pumping Fee: _ <br />Name: <br />b <br />VcjA <br />, <br />Long Pull Fee: <br />( <br />Address: <br />City/State/Zip: <br />Other Repairs: <br />Total Cost of Servi <br />V <br />Payment Method: El Check El Cash <br />El Credit <br />c Tank (chek i t <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 depth <br />designed operating depth <br />structural) <br />unsound <br />Septic/holding Tank #1 <br />Gallons: �2 <br />❑ Yes ❑-1115— <br />❑ Yes Et o <br />❑ Yes <br />Flo <br />Septic/holding Tank #2 <br />El Yes f1'No <br />El Yes ❑ No <br />El Yes <br />n'� <br />Gallons: � �9-� <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />Pump Tank <br />❑ Yes ❑ No <br />❑ Yes No <br />El Yes <br />2-IN o <br />Gallons: l Z�' <br />How Accessed: aintenance Hole [_�_�ff_Y_e's <br />ce Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ No files ❑ No f!��-��^- <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />a F L­ ,;« , h,rRm, hr Le r /Pm al'r 7 Tf an_ exnlain in cnmments below. <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 />nMound <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: Z'Uastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons 2 &--o <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />IN, <br />