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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE C.3 - 2 ZO 2-0 <br />Maintenance Inspection Form <br />MPCA Lic. # 654. <br />Maintainer Jim <br />D Duane <br />9�1 ick <br />• Phone: 763-497-2764 <br />• Email: duanesepticCcenturylink.net <br />Pumping Fee: <br />Tank #2 ❑ Yes ❑-hto <br />N e: <br />IIV V VIIrC <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />Mound <br />Long Pull Fee: <br />❑ Risers leaking <br />A ress: <br />C_CX O'S_ CV -C3 u <br />�� 1 <br />&I ' <br />Other Repairs: <br />❑ Baffles <br />City/State/Zip: <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />orcovvl> <br />❑ Trenches <br />Total Cost of Servi e: <br />�'(_ , <br />- L <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />' <br />❑ Effluent Filter/screen <br />Tank (check If present) <br />Tank leaks below the <br />Tank leaks above the <br />Cleaned? ❑ Yes ❑ No <br />Maintenance hole cover is damaged, <br />Comments: <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structuralIV unsound <br />0,ele-p­fic/holding Tank #1 <br />Gallons: to-LTz <br />❑Yes E—No <br />❑ Yes El No <br />❑ Yes p' <br />Ed-S'eptic/holding Tank #2 <br />Gallons: Oh,--_17Oh,--_17�, <br />� <br />❑ Yes ` --N <br />❑ Yes Eelo <br />❑ Yes No <br />❑ Pretreatment Tank <br />Gallons: <br />_F <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Pump Tank <br />Gallons: ISO <br />❑ Yeso <br />El Yes U1N0 <br />❑ Yes 0-- o <br />How Accessed: RVaintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ Yes EHgb �� <br />s ❑ No /.•. •",� <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks. missina baffles. broken rnverc_ arr_ 2 rf cn ovn/aln in rnmmcnta Fal ., <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes ❑-hto <br />Pump Tank ❑ Yes ErNo <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: ❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />>12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />wak <br />✓•.. ^ f+yam ,—�� � �--��-' <br />