Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE q' "30' 2,.!r <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer = Jim <br />*'-Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />1NVn1rF <br />Pumping Fee. <br />Name: <br />�n <br />Jun <br />Long Pull Fee: <br />Address':(PI © <br />L <br />Lti Ir r <br />Other Repairs: <br />City/State/Zip: <br />Dvov"o <br />Total Cost of Se <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />ink leaks below the <br />Tank (check <br />gned operating depth <br />designed operating <br />depth <br />structural) unsound <br />2 Septic/holding Tank #1 <br />Yes <br />Yes 5 <br />Gallons: t Z5-0 <br />❑ lZNo <br />❑ Yes <br />G_1q_0_ <br />❑ f No <br />Septic/holding Tank #2 <br />❑ Yes Cn No <br />El Yes <br />❑ Yes o <br />Gallons: c� <br />.�No <br />U_'t <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />2'0'ump Tank <br />El Yes No <br />El Yes <br />E3 No <br />El Yes 0 No <br />Gallons: L�� <br />I <br />How Accessed: Iff Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Hales Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />'❑ No <br />Yes <br />of Yes ❑ No <br />t tiA--� <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, broken povers, etc.? If so, explain in comment�elow. <br />Tank #1 ❑ Yes in No <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />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 />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: ff'�Vastewater Treatment Plant LJ <br />Disposal Site: <br />Lime: <br />Gallons Z 3 az> <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />