Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE �- ( 3- 2 ti <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Name: IIVVUIt;t <br />Long Pull Fee: <br />Address: <br />Other Repairs: 6 <br />City/State/Zip: <br />nny►'�:_ Pt4,'x)0r&It-z <br />Total Cost of Service- <br />(` <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />�Z -7, 0 <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />designed <br />operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally unsound <br />B75eptic/holding Tank #1 <br />Gallons:lpco <br />❑ Yes <br />I;11�0 <br />❑ Yes <br />❑ Yes <br />G71�eptic/holding Tank #2 <br />❑Yes <br />Cf No <br />❑Yes C5 <br />Gallons: t 000 <br />No <br />❑Yes <br />❑ Pretreatment Tank <br />Gallo s: <br />❑ Yes <br />❑ No <br />El Yes ❑ No <br />El Yes ElNo <br />Pump Tank <br />Gallons:100 a <br />❑ Yes <br />No <br />ElYes � No <br />❑ Yes C�No <br />How Accessed: aintenance Hole <br />Scum/Slud.ge Measured <br />�Malnle7n�ance_H`olesSecurely Replaced: <br />Reason For Pumping: <br />❑ No <br />❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />C ked tanks. missing hafflaa hrnhan n /w ate 2 rF a ice;,. _,.. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes R1 No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />Z 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: ❑ Land Application: Wastewater Treatment Plant I <br />Disposal Site: <br />Lime: <br />Gallons Z0-910 <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 0 <br />