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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 553761 <br />DATE '4--f 2- 2-'7 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer P Jim <br />ick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />NNvnNrF <br />Pumping Fee: <br />Scum/S�ludd e Measured <br />Maintenance Holes Securely Replaced: <br />Name: _ <br />El Other (see attached) <br />2 -les El No <br />0 Yes ❑ No <br />["L'L <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />Long Pull Fee: <br />❑ Baffles <br />❑ Baffles <br />Address :*�c <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />10r <br />❑ Non-domestic waste <br />Other Repairs: <br />City/State/Zip: <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Total Cost ofS Ice: <br />Payment Method: ElCheck El Cash <br />El Credit <br />�3 7 �� <br />< leaks <br />below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check i ent) <br />designed <br />operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) <br />unsound <br />Septic/holding Tank #1 <br />El Yes <br />L'iVo <br />❑Yes Lf No <br />El Yes <br />9_<0_ <br />Gallons:,L�-� <br />eptic/holding Tank 42 <br />Yes <br />11 -No <br />Yes <br />Yes <br />Gallons: o-e1v <br />❑ <br />❑ C3�No <br />❑ <br />C�No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />0-15'Ump Tank <br />❑Yes (��tGo <br />Gallons: t, a 0 0 <br />El Yes <br />o <br />❑Yes <br />L�(lo <br />How Accessed: VVaintenance Hole <br />Scum/S�ludd e Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />2 -les El No <br />0 Yes ❑ No <br />["L'L <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />Cprked tanks, missing baffles, broken Sowers, etc.? If so, explain in commentsj;�e'fow. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes r1N o <br />Pump Tank ❑ Yes Eilno <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ZT Mound <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: and Application: ❑ Wastewater Treatment Plant <br />Disposal Site: L4 7Lime: Gallons1 Plowed: ❑Yes C3�o <br />Time: 3 7 Temperature: , ✓ pH: Z > 12 <br />Time: VTemperature: , c' pH: I Co > 12 <br />adv � <br />