Laserfiche WebLink
Septic Service, LL <br />1205 LaBeaux Ave N <br />St. Michael, MN 5531 <br />DATE I'Z3-2'L <br />aintenance Inspection Form <br />n MPCA Lic. # 654 <br />!::5�d <br />Maintainer[] Jim <br />Duane <br />ick <br />: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: 33© t¢ <br />Scum/Sludge Measured <br />Name: •� <br />� �V <br />Reason For Pumping: <br />!1 <br />ther (see attached) <br />C1Yes 0- o-_ <br />❑ Yes ❑ Ni <br />'kms-+ <br />p.GCck.s R <br />❑ Risers leaking <br />❑ Risers leaking <br />Long Pull Fee: <br />❑ Baffles <br />❑ Baffles <br />Address: <br />01_P ure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical Issues <br />Iff Trenches <br />13 3 <br />S <br />❑ Non-domestic waste <br />Other Repairs: <br />City/State/Zip: <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Total Cost of Service: <br />�—t t N L, <br />Payment Method: heck <br />❑ Cash <br />❑ Credit <br />33�.. <br />/01A <br />lD X330 <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />designed <br />operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) <br />unsound <br />eptic/holding Tank #1 <br />❑ Yes <br />❑-`o <br />❑ Yes El"No <br />❑ Yes <br />❑ No <br />Gallons: f," v <br />Septic/holding Tank #2 <br />El Yes <br />No <br />C1 Yes J2' No <br />❑Yes <br />❑ No <br />Gallons: <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pump Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />How Accessed: ❑ Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />!1 <br />ther (see attached) <br />C1Yes 0- o-_ <br />❑ Yes ❑ Ni <br />'kms-+ <br />/vo t'tiu 'WIt <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />cracked tanks, misslnq baffles, broken c2yers, etc.? Ifso, explain In comments below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes ❑ No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Mound <br />O Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated dralnfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />01_P ure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical Issues <br />Iff Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: 0-Gand Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons (3'----'> <br />Plowed: ❑ Yes <br />-f5- No <br />Time: <br />3zi <br />Temperature: o <br />pH: I Z> f <br />> 12 <br />Time: <br />Temperature: -70 <br />pH: I Z_ j <br />> 12 <br />