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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nAT1=��3-Z? <br />Maintenance Inspection Form <br />MP,CA Lic. # 654 <br />1.11 <br />Maintainer eJim <br />O Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVnICF <br />Pumping Fee: <br />Scum/Sludge Measured <br />MaintenanceHoles Securely Replaced: <br />Name: Le <br />L--- <br />ElYes ❑'IVo❑s <br />4�� <br />.Se //,, -f2 <br />❑ Risers leaking <br />n h 0fln <br />k 1 r- <br />❑ Elevated drainfield <br />Long Pull Fee: � <br />❑ Baffles <br />❑ Baffles <br />1 <br />Address: —70 0 `C\ Cr V � is l <br />/5"q , 11 <br />Other Repairs: <br />+� ' l,e k tL <br />c�� i <br />❑ Trenches <br />City/State/Zip: <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Total Cost of Service <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 />cracked, unsecured, or appears to be <br />designed operating <br />depth <br />designed operating depth <br />structural) unsound <br />Septic/holding Tank #1 <br />V <br />❑ Yes <br />Z No <br />❑ Yes No <br />❑ Yes <br />L-tq6­_ <br />Gallons: i 7_ <br />eptic/holdin Tank #2 <br />❑ Yes <br />0 No <br />El Yes Ca'No <br />El Yes <br />❑'No <br />Gallons: !'ZS <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />"Pump Tan <br />� <br />❑ ❑ �IVo <br />LI Yes <br />0 No <br />G <br />Gallons: 1�7 <br />❑ Yes <br />Yes <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />MaintenanceHoles Securely Replaced: <br />Reason Fpr Pumping: <br />ElOther (see attached) <br />ElYes ❑'IVo❑s <br />4�� <br />.Se //,, -f2 <br />J <br />OId you IdenClfy any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br />cracked tanks. misslna baffles, broken couefs, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes ZPWo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <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 O No <br />Comments: <br />Disposal: . O Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: 3 5 Lime: <br />Gallons z, <br />Plowed: <br />❑ Yes ,.-E]-,No <br />Time: c.3 <br />Temperature: <br />pH: ;. <br />_:; > 12--8-- <br />Time: f:} <br />Temperature: c'z ' <br />pH: <br />> 1 2--f�-' <br />P. <br />.,.�-'�-•. ,�`'�'`� �-".sem..-�-.-,,� ,�,-,�.,.,, ,�'.,�- �"s�.> <br />