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cher <br /> Maintenance Inspection Form <br /> MPC Lic. #L4286 <br /> Maintainer INIKJim <br /> ❑ Nick <br /> Service, LLC • Phone: 763-497-2764 <br /> Beaux Ave NE <br /> ael, MN 55376 • Email: duaneseptic@centurylink.net <br /> ki- Z,j- & INVOICE <br /> Fee: II a,5v Name: Act ,,, pot Li <br /> I Fee: Address: ob 61.1-, S-k,e., At <br />:pairs: City/Statedip: <br /> ©rvyt-ci <br /> St of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> i/ iji ). <br /> Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, <br /> Ik(check if present) cracked,unsecured,or appears to be <br /> designed operating depth designed operating depth structurally unsound <br /> hoing Tank#1 <br />(U ❑ Yes Et< 0 Yes 12-- o 0 Yes 12'‹ <br /> hol�diU�ank#2 0 Yes No 0 Yes ❑ ❑ Yes G�No <br /> fitment Tank ❑ Yes 0 No 0 Yes 0 No 0 Yes 0 No <br /> rank ❑ Yes 0 No 0 Yes 0 No 0 Yes 0 No <br />;ssed:©Maintenance Hole Scum/Slud a Measured Maintenance les Securely Replaced: Reason For umping: <br /> 9 P <br /> ❑Other(see attached) 0 Yes Ca'No Yes 0 No <br /> Did you identify any operational issues or unsafe condition .white assessing the sewage tanks In this system, I.e., <br /> ed tanks,missing baffles,broken rs,etc.?If so, explain In comments below. <br /> ❑ Yes Wao Tank#2 ❑ Yes o Pump Tank ❑ Yes ❑ No System <br /> Structural integrity 0 Structural integrity 0 Structural integrity 0 Mound <br /> 3isers leaking 0 Risers leaking ❑ Risers leaking 0 Eleva d drainfield <br /> 3affles 0 Baffles 0 Baffles 0 P sure bed <br /> Jon-domestic waste 0 Non-domestic waste 0 Electrical issues renches <br /> ❑ Non-domestic waste 0 Ponding/Surfacing <br /> ❑ Effluent Filter/screen 0 Other: <br /> Cleaned? 0 Yes 0 No <br /> its: <br /> Disposal: 0 Land Application: Clt Wastewater Treatment Plant ki„ga4,:Viswti <br /> Site: Lime: Gallons Plowed: 0 Yes 0 No <br /> Temperature: pH: >12 0 <br /> Temperature: pH: >12 0 <br /> ,. , *AV THANKS! . . ...$, <br />