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richer <br /> Maintenance Inspection Form <br /> MPC ic. #L4286 <br /> Maintainer Jim <br /> ❑ Nick <br /> Service, LLC •Phone: 763-497-2764 <br /> aBeaux Ave NE <br /> hael, MN 55376 • Email: duaneseptic@centurylink.net <br /> INVOICE <br /> • <br /> ig Fee: 1157.CD Name: V-2 1 h T <br /> ull Fee: Address: � - <br /> t 2%1 `i 1=4(i vi{ 1— <br /> iepairs: City/State/Zip: <br /> Ci CO" <br /> ost of Serv' : Payment Method: Cl Check 0 Cash 0 Credit <br /> Lg ' 5b <br /> Tank leaks below the Tank leaks above the Maintenance hole cover Is damaged, <br /> ank(check if present) cracked,unsecured,or appears to be <br /> designed operating depth designed operating depth <br /> structurally unsound <br />/holding Tank#1 <br /> ❑ Yes r�No� ❑ Yes Cad^ 0 Yes ❑ <br /> c/holding Tank#2 Cl Yes t7 No 0 Yes ❑ Yes CYI10 <br /> aatment Tank 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No <br /> Tsk-- 0 Yes 0 Yes Et'No ❑ Yes iff No <br /> cesse . Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br /> 0 Other(see attached) , ❑Yes �❑ No .tlr Yes ❑ No <br /> Did you Identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, I.e., <br /> /ticked tanks,missing baffles,broken ers,etc.?If so, explain In comme Blow. <br /> I 0 Yes t�`No Tank#2 0 Yes No Pump Tank 0 Yes ❑ No System- <br /> Structural integrity 0 Structural integrity CI Structural Integrity ound <br /> Risers leaking ❑ Risers leaking 0 Risers leaking 0 Elevated drainfield <br /> Baffles ❑ Baffles El Baffles 0 Pressure bed <br /> Non-domestic waste 0 Non-domestic waste 0 Electrical issues 0 Trenches <br /> ❑ Non-domestic waste 0 Ponding/Surfacing <br /> 0 Effluent Filter/screen 0 Other: <br /> Cleaned? 0 Yes 0 No <br />;nts: <br /> Disposal: 0 Land Application: C'1 Wastewater Treatment Plant 1A,q 1rr"row\- <br /> al Site: Lime: Gallons Plowed: 0 Yes 0 No <br /> Temperature: pH: >12 0 <br /> Temperature: pH: >12 0 <br /> G' , ,ail ��, Q THANKS! CSC' ��t" �� c ...� <br />