Laserfiche WebLink
Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 5 - % ,,)-q <br />Maintenance Inspection Form <br />VCim, <br />ic.#L4286 <br />Maintainer <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />INVnICF <br />Pumping Fee- <br />Name: <br />00 kl 10 <br />Long Pull Fee: <br />Address: <br />6. <br />Sk <br />f 4 wvj <br />(2 <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Service: <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />designed operating depth <br />designed operating depth <br />structural) <br />unsound <br />eptic/holdin Tank #1 <br />❑ Yes <br />No <br />❑ Yes � <br />❑ Yes <br />f_lo <br />Gallons: . Z j-o <br />tic/holdinngq Tank #2 <br />Gallons: /i s U <br />❑Yes <br />P_15_0� <br />❑ Yes No <br />❑ Yes <br />r-No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />ump Tank <br />Gallons: <br />El Yes <br />No <br />❑Yes o <br />El Yes <br />I <br />How Accessed: Maintenance Hole <br />❑ <br />Scum/Sludge Measured <br />Maintenance les Securely Replaced: <br />Reason Fox Pumping: <br />Other (see attached) <br />❑ Yes ❑ <br />Yes ❑ No <br />Did you identify an4, operational issues or unsafe conditions w ile assessing the sewage tanks in this system, i.e., <br />d tanks, missing baffles, broken c s, etc.? If so, explain in comments_�Oow. <br />Tank #1 ❑ Yes 2no <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <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 />❑ 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: I ❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: r I <br />Lime: <br />Gallons <br />Plowed: El Yes �` No <br />Time: <br />Temperature: — <br />pH: - -- > f2_-❑ <br />Time: <br />Temperature: <br />pH: <_ > 12 ❑ <br />,✓+- ;4�M/ <br />ue. - ,✓--' �''- sZ41�jo <br />