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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 6- -- •7-'2 z <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer O Jim <br />Duane <br />dg,Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVnIrF <br />Pumping Fee:Name: <br />4 3 S-0 e <br />Scum/Sludge Measured <br />%a v <br />Reason For Pumping: <br />El Other (see attached) <br />Long Pull Fee: <br />Erl�e-s ❑ No <br />Addre s: _ <br />r R <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />el <br />❑ Baffles <br />Other Repairs: <br />❑ Non-domestic waste <br />City/State/Zip: <br />❑ Electrical issues <br />❑ Trenches <br />VrC9 <br />" <br />Total Cost of Service: <br />71- <br />Payment Method: <br />Check ❑ Cash <br />O Credit <br />Comments: <br />3J� <br />4370 <br />3700,0 <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 depth <br />designed operating <br />depth <br />structural) <br />unsound <br />P-S-e-ptic/holding Tank #1 <br />Gallons: [Z 0+ <br />❑ Yes 0 o- <br />❑ Yes <br />20— <br />0 Yes <br />O'IQo <br />EF,5eptic/holding Tank #2 <br />Gallons: t Z X10 <br />❑ Yes �o <br />❑ Yes <br />2-11TO, <br />❑ Yes <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />l�'ump Tank <br />Gallons: t ZS <br />❑ Yes ❑'No <br />❑ Yes <br />C3'N0 <br />❑ Yes <br />C1-Ido— <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />❑ Yes ❑'No <br />Erl�e-s ❑ No <br />ound <br />Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />hacked tanks, miss/ng baffles, broken_govers, etc.? If so, explain in comments -below. <br />Tank #1 ❑ Yes CA o <br />Tank #2 ❑ Yes 6No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural Integrity <br />ound <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: D-E-a-nd Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: <br />Gallons Z /sJ <br />Plowed: ❑ Yes <br />❑ No <br />Time: ©Z t <br />Temperature: <br />pH: ( 2 - $ <br />> 12 El - <br />Time: 10,5-1 <br />Temperature: C0 v <br />pH: ( z - j <br />> 12 is <br />