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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 1/ - d 5 - a'( <br />Maintenance Inspection Form <br />MPPCA Lic. #L4286 <br />Maintainer � Jim <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Name: <br />�rGr <br />IIV V VIV�- <br />Long Pull Fee: <br />Address: <br />UL-,� <br />7 r <br />ll -_ <br />i/i(.f/ <br />Other Repairs: <br />City/State/Zip: <br />C" tl <br />- ------------- <br />Total Cost of Service: (-4-1�.� <br />Payment Method: <br />ElCheck <br />ElCash <br />ElCredit <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 />Septic/holding Tank #1 <br />Gallons: iooD <br />❑Yes ElNo <br />❑Yes <br />❑ No <br />El Yes <br />ElNo <br />❑ Septic/holding Tank #2 <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />❑ Pump Tank <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />How Accessed: ❑ Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />'Other (see attached) ❑ Yes �EA_0 -fn Yes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />i- . Lec ,,,icdnn harflec_ hroken covers. etc. ? If so, explaln in comments below. <br />Tank #1 ❑ Yes O No <br />Tank #2 ❑ Yes ❑ No <br />Pump Tank ❑ Yes ❑ No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ PLe6sure bed <br />❑ Non -domestic waste <br />❑ Non -domestic waste <br />❑ Electrical issues <br />renches <br />❑ Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: u Vvaslewaier iiGauiIV[ n ruin <br />Disposal Site: Lime: Gallons <br />Time: Temperature: <br />Time: Temperature: <br />Plowed: ❑ Yes ❑ No <br />pH: > 12 ❑ <br />pH: > 12 ❑ <br />�ir -w •� 1 / '� .^—�' Q� J® '� .mot �ir . .� ���/ � �..� <br />•�,, �.�-r sue. ,..�- � <br />