Laserfiche WebLink
icher <br /> Maintenance Inspection Form <br /> MP/CA Lic. #L4286 <br /> Maintainer I� Jim <br /> ❑ Nick <br /> Service, LLC • Phone: 763-497-2764 <br /> aBeaux Ave NE <br /> lad, MN 55376 • Email: duaneseptic@centurylink.net <br /> q,3.0 ..2q INVOICE <br /> g Fee: ` f U ca° (yi:* ,4 Name: <br /> all Fee: 50 2- 140 oto L1I Address: SLil �%r tic <br /> epairs: City/State/Zip: <br />)st of Service: Payment Method: ❑ Check ❑ Cash ❑ Credit <br /> Qi Si ;.)- ' E;) <br /> Maintenance hole cover is damaged, <br /> Tank leaks below the Tank leaks above the cracked, unsecured,or appears to be <br /> ink(check if present) designed operating depth designed operating depth <br /> structurally unsound <br />;Molding Tank#1 ❑ Yes 0'No ❑ Yes No El Yes CiNo <br /> i�� <br />/holdin Tank#2 ❑ Yes prgO ❑ Yes CrNo ❑ Yes No <br />:atment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> Tan ❑ Yes7 No ❑ Yes `Cl No El Yes �l No <br /> S <br /> 3essed:4aintenance Hole Scum/Sludge Measured Maintenance oles Securely Replaced: Reason For Pumping: <br /> ❑Other(see attached) ❑Yes No C es El No "�. <br /> Did you identify a operational issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br /> cked tanks,missing baffles, broken ers, etc.?If so, explain in commentsow. <br /> ❑ Yes No Tank#2 ❑ Yes No Pump Tank ❑ Yes ."-"No System s� <br /> G� <br /> Structural integrity ❑ Structural integrity ❑ Structural integrity 'fNound <br /> Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield <br /> Baffles ❑ Baffles ❑ Baffles El 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 0 No <br /> nts: <br /> Disposal: ❑ Land Application: ll Wastewater Treatment Plant V/A-T,.tr t U <br /> il Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br /> Temperature: pH: >12 O <br /> Temperature: pH: >12 ❑ <br /> 0 (431.140 THANKS! ,0.1 <br /> ie, • e i ..—S, <br />