Laserfiche WebLink
DV�NE�� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE en-1"i1- ZJf <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />ick <br />Sam <br />® Phone: 763-497-2764 <br />® Email: duanesepticCcenturylink.net <br />iMMUIP <br />Pumping Fee. <br />Name: <br />Long Pull Fee <br />Address: <br />,,nn {�,, <br />Other Repairs <br />City/State/Zip: <br />Total Cost of <br />ki <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />s below the <br />Tank (chef <br />operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />2'9eptic/holding Tank #1 <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />D eptic/holding Tank #2 <br />Gallons: --�-�a <br />El Yes <br />El No <br />El Yes El No <br />El Yes El No <br />❑ Pretreatment Tank <br />Gallons: <br />ElYes <br />❑ No <br />I]Yes ❑ No <br />ElYes I]No <br />❑ Pump Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />How Accessed: <br />1 Mai. tenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />Other (see attached) ❑Yes El No ❑ Yes ❑ No Aje�5 <br />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, broken covers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes ❑ No <br />Tank #2 ❑ Yes ❑ No <br />Pump Tank ❑ Yes ❑ No <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: [?`Wastewater Treatment Plant t, ,q,4</ L✓�+ <br />Disposal Site: <br />Lime: <br />Gallons / <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />,✓�-�-�- � sue. � ,.,r•-'�-•- ,��" s�- <br />