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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE %-9-2L <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />-0Duane <br />7Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />IhIVP\1/'�c <br />Pumping Fee: _ ,3 �. <br />Scum/Sludge Measured <br />Nam : <br />-- �� Cly <br />; <br />' I t <br />Long Pull Fee: <br />2-1-5-s ❑ No <br />ound <br />Address: <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfleld <br />❑ Baffles <br />. 7 _T- Cry <br />❑ Baffles <br />Other Repairs: <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />City/State/Zip: <br />❑ Trenches <br />❑ Non-domestic waste <br />0 0'0 v�- 0 <br />Total Cost of Service: <br />❑ Other: <br />-� % <br />Payment Method: Check L1 Cash El Credit <br />Cleaned? ❑ Yes ❑ No <br />Comments: J <br />E.G. �. ~�---,.1 �2.�-�. �:,� .��- x. e�5 �6✓� �- -j'(,.� -�-4,� % . <br />�l / - <br />Li C <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 />D-geptic/holding Tank #1 <br />Gallon • �" <br />❑ Yes <br />ff No <br />❑ Yes ❑No <br />❑ Yes 1f No <br />Septic/holding Tank #2 <br />❑Yes <br />_ <br />Gallons:� E Q� <br />No <br />EJ Yes 1 No <br />❑ Yes i❑—Mo <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />ump Tank <br />ElC� <br />Yes <br />Gallons: l �.� <br />No <br />❑ Yes Cr No <br />❑ Yes ❑�!s <br />How Accessed: ET Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes Eir <br />2-1-5-s ❑ No <br />ound <br />Did you Identify any operational Issues or unsafe conditions while assess/ng the sewage tanks in this system, I.e., <br />cracked tanks, missina baffles, broken covers. etc.? If so. exnialn in rnmmenhc helnw. <br />Tank #1 ❑ Yes ❑ o <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes ff No <br />System <br />❑ Structural Integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <br />Q Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfleld <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: J <br />E.G. �. ~�---,.1 �2.�-�. �:,� .��- x. e�5 �6✓� �- -j'(,.� -�-4,� % . <br />Disposal: (77"Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />I Lime: <br />Gallons L Z -cc <br />Plowed: ❑ Yes <br />•❑ No <br />Time: <br />/60f <br />Temperature: H <br />pH: I L. 3 <br />> 12 a' <br />Time: <br />1639 <br />Temperature: 4-& <br />pH: i 2. 3 <br />> 12 CT' <br />