Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />r)ATF L 1'�-' 1 <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />O Duane <br />"Nick <br />.ori ���1 • Phone: 763-497-2764 <br />a ��± w"e- A `� • Email: duaneseptic@centurylink.net <br />Pumping Fee:1-3z <br />;J <br />Maintenance Holes Securely Replaced: <br />Name: <br />❑ Other (see attached) <br />❑ Yes ❑' No <br />{] <br />1 3 z W <br />❑ Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />Long Pull Fee: <br />❑ Baffles <br />❑ Baffles <br />Address: <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />Other Repairs: <br />❑ Effluent Filter/screen <br />City/State/Zip: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />A <br />Total Cost of Service: <br />Payment Method: <br />heck El Cash <br />1:1 Credit <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally <br />unsound <br />El Septic/holding Tank #1 <br />Gallons: <br />❑ Yes <br />❑yNo <br />❑ Yes O No <br />❑ Yes <br />El -No <br />❑ Septic/holding Tank #2 <br />Gallons: <br />❑ Yes <br />O" No <br />❑ Yes ❑ No <br />❑ Yes <br />E]'No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />11 Pum Tank <br />k <br />Gallons:. ''- <br />ElYes <br />ElNo <br />❑ Yes D No <br />ElYes <br />_❑--No <br />How Accessed: ❑ Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes ❑' No <br />E]'Yes ❑ No <br />❑ Mound <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: ❑'end Application: ❑ Wastewater Treatment Plant <br />)isposal Site: 34 <br />Lime: <br />Gallons 2 -,c --o <br />Plowed: ❑ Yes <br />❑ No <br />-ime: <br />'T y, <br />Temperature: <br />pH: f 2- 3 <br />> 12 Ca' <br />-ime: <br />to L,;� <br />Temperature: �, , <br />pH: t 2 - � <br />>12 ❑ <br />s�- <br />