05-05-2022 Septic Maintenance Form

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Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 nATF 5- S_zZ Maintenance Inspection Form MP A Lic. # 654 Maintainer Jim EJ Duane = Nick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net Pumping Fee: 3737 3-t5A_5 Name: v i� 014 111 V Long Pull Fee: --106 Address: 700 C3'Yes El No ,G ❑ Elevated drainfield ❑ Baffles Other Repairs: ❑ Pressure bed City/State/Zip: ❑ Non-domestic waste ❑ Electrical issues ❑ Trenches 0 ❑ Ponding/Surfacing Total Cost of Service: ❑ Other: Payment Method: eck ❑ Cash ❑ Credit Cleaned? ❑ Yes ❑ No �00 r Comments: Tank (check If present) Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be designed operating depth designed operating depth structural) unsound �c/holdiTank #1 Gallons:1 �(J5 ❑ Yes 1'No ❑ Yes ffl- 'No ❑ Yes 0-90—, Septic/holding Tank #2 Gallons: U`� El Yes t'I No 1:1 Yes Er -R-0— ❑ Yes C3 -f -o ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No El Yes ❑ No ❑ Yes ❑,No � ns Tank Gallons: � S�C� ❑ Yes � No ❑ Yes s'No - iso ❑ Yes No How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced:710" ason For P mping: 171 Other (see attached) 11 Yes � C3'Yes El No ,G Did you Identify an . operational issues or unsafe conditions while assess/ng the sewage tanks in this system, I.e., cked tanks, misslna baffles, broken covers. etc.? Ifso. exnlaln In cnmmentc hr lnw Tank #1 ❑ Yes o Tank #2 ❑ Yes o Pump Tank ❑ Yes o System ❑ Structural Integrity ❑ Structural integrity ❑ Structural Integrity ound ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield ❑ Baffles ❑ Baffles Cl Baffles ❑ Pressure bed ❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues ❑ Trenches ❑ Non-domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: _---❑ Land Application: ❑ Wastewater Treatment Plant Disposal Site: 3 C? Lime: / Gallons Z U Plowed: ❑ Yes D_No Time: Temperature: pH: i :_ :; >12 Time: Temperature: ,, pH: > 12 ��1 .tet ,��4�v �� / � • `� � Qa� � ,�% •�.G � � '� �� / •� •.�]i' ,•.i--'�-•� � '`"sem. ,.�-'�=�� ,�`'r '�'��: