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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />Maintenance Inspection Form <br />MPCA Lic. #1_4286 <br />Maintainer 1 Jim <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: <br />Long Pull Fee: � �C <br />Address: �a-? 6 <br />folio v /-C t") nor <br />Other Repairs: � <br />U <br />f.2�.i> <br />City/State/Zip: <br />CQuv-. <br />() rotn6 <br />vo- <br />Total Cost of Service: 4- A <br />1110 <br />Payment Method: ❑ Check <br />❑ Cash ❑ Credit <br />Tank (check if present) <br />Tank leaks <br />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/holding Tank #1 <br />❑ Yes <br />�� <br />®"No <br />❑ Yes No <br />❑ Yes No <br />Gallons: � j,� <br />peptic/holding Tank #2 <br />❑ Yes <br />Zf No <br />❑ Yes 0_1qo <br />❑ Yes <br />Gallons: 1000 <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Pump Tank <br />❑ Yes <br />P-N-0 <br />❑ Yes No <br />❑ Yes No <br />Gallons: I oUv <br />How Accessed. aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) 1 <br />❑ Yes o <br />es ❑ No <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, he., <br />—f—d f,nt,, mtcelnn haff nc hrnlepn rnvarc, atc.7 if So. exnlaln In comments below. <br />Tank #1 ❑ Yds ZWo <br />Tank #2 ❑ Yes f5No <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: ❑ Land Application: D Wastewater Treatment Plant L, 3 0 .- , . --w "'— <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />