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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE .- ? @ <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />D Duane <br />=' Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />IAI\/nlr%c <br />Pumping Fee:.- <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Name: <br />❑ Other (see attached) <br />❑ Yes El No <br />Yes ❑ No <br />❑Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />Long Pull Fee: - <br />❑ Baffles <br />❑ Baffles <br />Address:.,_,, <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />Other Repairs: <br />❑ Ponding/Surfacing <br />City/State/Zip: <br />❑ Effluent Filter/screen <br />❑ Other: <br />01 <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Total <br />Total Cost of Service:-� <br />f lr <br />Payment Method: <br />❑ Check ❑ Cash ❑ Credit <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) unsound <br />❑ Septic/holding Tank #1 <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />0- Nd <br />❑ Yes ❑ No <br />p'Septic/holding Tank #2 <br />Gallons: ''..._ _ <br />El Yes <br />El -,No <br />El Yes <br />❑ No <br />El Yes ElNo <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Pump Tank <br />Gallons:.° <br />El <br />❑Y'No <br />El Yes <br />❑, No <br />El Yes No <br />How Accessed: El Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes El No <br />Yes ❑ No <br />❑Mound <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks, missing baffles, broken covers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes ❑ No <br />Tank #2 ❑ Yes ❑ 'No <br />Pump Tank ❑ Yes ❑ No <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 />)isposal Site: .30 <br />Lime: / <br />Gallons 2 <br />Plowed: <br />❑ Yes <br />❑ No <br />-ime: <br />((2-7 <br />Temperature: <br />pH: <br />2.3 <br />> 12 Ei- <br />-ime: <br />y 2 &10 <br />Temperature: <br />pH: <br />)2.3 <br />> 12 [m3- <br />,.,/'`�-�, �.r- sem- -�'' ,✓'-'�-� ,�'''�"s�- <br />