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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE'q- 2- 2,2 - <br />Maintenance <br />2 -- <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer 0 Jim <br />Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />infvnirF <br />Pumping Fee:Na. <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />: <br />El Other (see attached) <br />Long Pull Feer <br />tomes ❑ No <br />- '4, t <br />Address: <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />thr;Rep irs: <br />❑ Electrical issues <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: <br />❑ Check D<ash ❑ Credit <br />i`% <br />J <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />designed operating depth <br />designed operating <br />depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />eptic/holding Tank #1 <br />— <br />Gallons: j�O <br />❑ Yes <br />7'CTo <br />❑Yes <br />C5 No <br />❑Yes �No� <br />95"Septic/holding Tank #2 <br />Gallons: <br />❑ Yes <br />f _No <br />❑ Yes <br />�- - <br />❑ Yes =_N_0 <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />ump Tank <br />Gallons: i.�� <br />❑ Yes <br />No <br />❑ Yes <br />C�,'No <br />ElYes <br />How Accessed. aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />El Yes l� M- <br />tomes ❑ No <br />- '4, t <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />clacked tanks, missing baffles, broken covers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <br />El 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: [?"Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: / Gallons t -1a-0 Plowed: ❑ Yes -tno <br />Time: 1 L(C1Temperature: -70 pH: 12 > 12 A <br />Time: 2.161 Temperature: "7 1 pH: 1-2.1 > 12 <br />��l .fit �• r/!'^� �r/ '� � � �� �,,� ��l ��L �, ✓! ��,�,/ � <br />