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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nATF L5-6-22— <br />Maintenance Inspection Form <br />MPGA Lic, # 654 <br />Maintainer u� J/im <br />D Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: JSiJ <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Name: <br />k <br />IIVvultit <br />❑Yes 0-M-0, <br />ales ❑ Nc <br />0—Mound <br />Gj.e��r1�v, <br />t� <br />Long Pull Fee: <br />❑ Elevated drainfield <br />❑ Baffles <br />Address: <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-dome$tic waste <br />❑ Non-domestic waste <br />7) L <br />Other Repairs: <br />. <br />City/State/Zip: <br />❑ Ponding/Surfacing <br />❑ Effluent Fllter/screen <br />0 rv.rt o <br />Total Cost of Service: �, <br />) <br />Comments: <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover Is damaged, <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) <br />unsound <br />Septic/holdin�nk #1 <br />Gallons: 1 <br />❑ Yes <br />Flo <br />❑ Yes EriTo <br />❑ Yes <br />' Septic/holding Tank #2 <br />Gallons: 1 z) -v <br />❑Yes <br />❑Yes ( <br />❑ Yes <br />DY<O <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />amp Tank <br />❑ Yes <br />Gall� Zj� <br />Gall <br />No <br />❑ Yes No <br />E3ons: Yes <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For umping: <br />El Other (see attached) <br />❑Yes 0-M-0, <br />ales ❑ Nc <br />0—Mound <br />Did you fdentlfy�a"operational Issues or unsafe conditions while assess/ng the sewage tanks in this system, i.e., <br />�CP3CK'd tanks. mlccinn haffia hmLnn <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes No <br />--I--�---....- --......_........ <br />Pump Tank ❑ Yes o <br />... <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural Integrity <br />0—Mound <br />0 Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-dome$tic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />O Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Fllter/screen <br />❑ Other: <br />Cleaned? ElYes ❑ No <br />Comments: <br />Disposal: .„,-'Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: 3 f7a Lime: Gallons ,1� y Plowed: ❑ Yes —ff-No <br />Time: 1 '30 Temperature: s ; <br />H: <br />p 7 , > 12--a- <br />Time: <br />Time: 2 Temperature: S y pH: = .? > 12 "D— <br />