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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 5--6-22— <br />Maintenance Inspection Form <br />MPGA Lic. # 654 <br />Maintainer Jim <br />Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />l \\►!rl r'Ami <br />Pumping Fee: J <br />SCS. <br />Scum/Sludge Measured <br />Name: j� <br />•�'e <br />Reason For,umping: <br />❑ Other (see attached) <br />❑ Yes ❑-flo <br />G) f'►" ` .o v� <br />rl <br />Long Pull Fee: <br />❑ Baffles ❑ Baffles <br />❑ Baffles <br />Address: <br />Other Repairs: <br />❑ Electrical issues <br />❑ Trenches <br />City/State/Zip: <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />v r0 -� <br />Cleaned? ❑ Yes ❑ No <br />Total Cost of Service: <br />Comments: <br />Payment Method: ❑ Check ❑ Cash ❑ 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/holdln,gnk #1 <br />Gallons: I Z_✓ <br />E3 Yes <br />2-K-0 <br />11 Yes ©'Ro <br />❑Yes to <br />Septic/holding Tank #2 <br />Gallons: f 'Z) -o <br />❑ Yes <br />11 -No <br />❑ Yes 9_1q0__ <br />❑ Yes l -No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />19419m—p Tank <br />Gallons: j ZJ—D <br />❑ Yes <br />K No <br />❑ Yes No <br />❑ Yes ['-]�o <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For,umping: <br />❑ Other (see attached) <br />❑ Yes ❑-flo <br />2 es ❑ No <br />❑ Risers leaking <br />Old you Identify a Operational Issues or unsafe conditions while assessing the sewage tanks In this system, Le., <br />acked tanks, missing baffles, broken gwertetc.? Ifso, explain In comments below - <br />Tank #1 ❑ Yes ET No Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity ❑ Structural Integrity <br />❑ Structural integrity <br />ound <br />❑ Risers leaking ❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles ❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste ❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />pH: <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: 3 R Lime: <br />Gallons <br />6 ,,.,<, <br />Plowed: <br />❑Yes <br />--CI-No <br />Time: t 3 ra <br />Temperature: <br />s ? <br />pH: <br />( 7, <br />> 12--a- <br />Time: 2 r <br />Temperature: <br />c y <br />pH: <br />? <br />> 12 `El- <br />'...�-'.TUI <br />