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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MNN 55376 <br />DATE G N'ZZ— <br />Maintenance Inspection Form <br />rill <br />A Lic. # 654 <br />Maintainer <br />Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />itivnirr1= <br />Pumping Fee: S70 <br />Scum/Sludge Measured <br />Name: i a <br />I 14 <br />Long Pull Fee: <br />❑ Structural integrity <br />Address: <br />2�Ab <br />i 0 �. <br />Other Repairs: <br />El Yes [�No <br />City/State/Zip: <br />�n•.�^�i 1 <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />�— <br />Total Cost of Service., _ <br />❑ Electrical issues <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 depth <br />designed operating depth <br />structural) unsound <br />Septic/holdin nk #1 <br />Gallons: i Z.) <br />❑ Yes <br />2_1q_0 <br />❑ Yes No <br />❑ Yes 1_=k<0 <br />eptic/holding TAnk #2 <br />Gallons: j , L 5,-L-) <br />❑ Yes <br />C'No <br />❑ Yes51 No <br />❑ Yes E^--O-- <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />� Pump TankI]Yes <br />13Yes <br />Gallons: j 25D <br />No <br />E;.I o <br />EDYes No <br />How Accessed. Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumpiifig: <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <br />EJ Other (see attached) <br />El Yes [�No <br />B'Yes El No <br />�n•.�^�i 1 <br />Did you identify a y operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />_xfacked tanks, missing baffles, broken_Peve-rs, etc.? if so, explain in comments—te �ow. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes KrNo <br />Pump Tank ❑ Yes No <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 />Disposal1. un I _a.dJ „Appl1:tca1u:o. �1AA/c�ts_itc_.w..a♦Le. <br />11 CaolICIn Flatn n,�}.ripyP.N <br />Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br />Fime: Temperature: pH: > 12 ❑ <br />Fime: Temperature: pH: > 12 ❑ <br />