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4Eicher <br /> Jim <br /> Maintenance Inspection Form <br /> MPC -ic. #L4286 <br /> _ATI Maintainer Jim <br /> DIMES ❑ Nick <br /> Septic Service, LLC • Phone: 763-497-2764 <br /> 1205 LaBeaux Ave NE <br /> St. Michael, MN 55376 • Email: duaneseptic@centurylink.net <br /> h <br /> DATE % - E l - 2Y INVOICE <br /> Pumping Fee: Name: <br /> LI(oa.SQ 3bua (,- cl .� 1-1 os i i a ( � 0v4.rt <br /> Long Pull Fee: �� z tO t Address: I�1 C 0 x F ,- e, <br /> Other Rep ' City/State/Zip: <br /> p rr vt <br /> Total Cost of Servic Payment Method: E Check III Cash ❑ Credit <br /> 1 <br /> Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, <br /> Tank(check if present) cracked,unsecured,or appears to be <br /> �� designed operating depth designed operating depth structurally unsound <br /> C�'Septic/holding Tank#1 ❑ Yes lie/ ❑ Yes ❑4� ❑ Yes LY <br /> Gallons: /d,,5 <br /> Bptic/holding Tank#2 ❑ Yes CT No ❑ Yes �IVo ❑ Yes 0'No <br /> Gallons: (;)-J Z) <br /> ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes El No ❑ Yes ❑ No <br /> Gallons:'Pu �� <br /> mp Tank ❑ Yes r No ❑ Yes ❑-'No ❑ Yes L` "No <br /> Gallons: ))- <br /> How Accessed:C-tdfaintenance Hole Scum/Sludge Measured 1 Maintenance Holes Securely Replaced: Reason <br /> F{or Pumping: <br /> ❑Other(see attached) ❑Yes CYNo Le Yes ElNo -„, <br /> Did you identify any operational issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br /> racked tanks, missing baffles, broken cov s, etc.?If so, explain in comments bew <br /> Tank#1 ❑ Yes o Tank#2 ❑ Yes q,Kfo Pump Tank ❑ Yes o System/ <br /> ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity Mound <br /> ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br /> ❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑ Trenches <br /> ❑ Non-domestic waste ❑ Ponding/Surfacing <br /> ❑ Effluent Filter/screen ❑ Other: <br /> Cleaned? ❑Yes ❑ No <br /> Comments: <br /> Disposal: El Land Application: 2-Wastewater Treatment Plant j,"T,yi o'"- <br /> Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br /> Time: Temperature: pH: >12 ❑ <br /> Time: Temperature: pH: >12 0 <br /> ,, •• �� Q THANKS! .► �...�,,� ^ _ ....t car ,,�"` A i <br />