Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 / <br />DATE 1( Z • Z_ <br />Maintenance Inspection Form <br />MPC,A Lic. #L4286 <br />Maintainer eiliim <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: L t) J <br />Name: <br />�e Va <br />O n <br />Long Pull Fee: <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />bJ <br />Total Cost of Service: <br />Payment Method: ❑ Check ❑ Cash <br />❑ 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 />4E7Septic/hoidinq Tank #1 <br />❑ Yes <br />Z No <br />❑ Yes O-No <br />❑ Yes <br />2f_No <br />Gallons <br />O-Septic/holdin9,Tank #2 <br />❑ Yes <br />)—,r-N o <br />❑ Yes 11_N0 <br />❑ Yes <br />Q-- o <br />Gallons: i 3 u J <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pump Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />How Accessed: C3 Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />1 <br />Reason For Pumping.. <br />❑ Other (see attached) <br />❑ Yes a-k-0 <br />-0 Yes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cked tanks, missing baffles, brokenlovers, etc.? rfso, explain In comments below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes No <br />Pump Tank E.7 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 />❑ �P assure bed <br />❑ Non -domestic waste <br />❑ Non -domestic waste <br />❑ Electrical Issues <br />Trenches <br />❑ Non -domestic waste <br />❑ PondingfSurtacing <br />❑ E111uent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: ❑ Wastewater Treatment Plant <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 />