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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />neTIF i- im _1) t <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />f kw' 0 T914 <br />Pumping Fee: <br />Lei - caS' <br />Name: <br />S vv <br />Long Pull Fee: <br />Address <br />Other Repairs: <br />City/State/Zip: <br />t� rr-t>✓�J <br />Total Cost o ervice: <br />Payment Method: <br />❑ Check ❑ Cash ❑ Credit <br />c�f <br />"1' <br />7 Z p %P,,� <br />Tank (c '-presea <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 />structurally unsound <br />ErS-eptic/holding Tank #1 <br />❑ Yes <br />nf No <br />❑ Yes <br />C-f�- <br />❑ Yes O- lo <br />Gallons: a f--Lp.� <br />13_ <br />Septic/holding Tank #2 <br />❑ Yes <br />C(No <br />❑ Yes <br />� <br />❑ Yes �o <br />Gallons: � 5-Zy.� <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />ump Tank <br />❑ Yes <br />a No <br />❑ Yes <br />KIN o <br />❑ Yes B� <br />Gallons: / S-L-2 <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ <br />1'vl,fc-. T" <br />El Other Other (see attached) <br />©❑ No <br />Ca-les No <br />n <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />L,mrf t>n Lc miccinn hafflochrnitPn rnvarc_ Ptr.7 rf Sn. Pxnlaln In comments_ below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes No <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 />❑ tiar --'domestic waste <br />❑ Ponding/Surfacing <br />EI-Effluent Filter/ reen <br />❑ Other: <br />Cleaned? Cnes ❑ No <br />Comments: <br />Disposal: 3"Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons 6LV D <br />Plowed: <br />❑ Yes <br />L'Jo <br />Time: ) p 'L- <br />Time: 11Temperature: <br />Temperature: ref <7 <br />f � , l <br />pH: <br />pH: <br />I Z <br />> 12 <br />