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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE �"I;., - <br />Maintenance Inspection Form <br />MPCCA Lic. #L4286 <br />Maintainer A Jim <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink,net <br />Pumping Fee: <br />i -ate <br />� <br />Name: <br />iNVUIL;t <br />Long Pull Fee: <br />Address: <br />Other Repairs: 4- <br />City/State/Zip: <br />Total Cost of Service: Q <br />Payment Method: ❑ Check ❑ Cash <br />Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) <br />unsound <br />Septic/holdingTank #1 <br />Gallons: ),'D <br />❑ Yes <br />CYNo <br />❑ Yes <br />❑ Yes <br />If'Septic/holding Tank #2 <br />Gallons: � a- j-0 <br />❑ Yes <br />a -No <br />❑ Yes DIK <br />❑ Yes <br />2-No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />lap Tank <br />Gallons: <br />❑ Yes <br />o <br />;A' <br />�E]Yes ❑ <br />El Yes <br />E�I�o <br />How Accessed aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason Pumping: <br />❑ Other (see attached) <br />❑ Yes ©'IV0� <br />❑ No <br />/For <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks. missinn hafflac hrnllan rn.�� nt, 71 ry � ., ;,;_ <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 />❑ 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 1-1No <br />Comments: <br />Disposal: ❑ Land Application: �12-Wastewater Treatment Plant l,') /-_ _',_ , <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes <br />r❑ No <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />!� .mot �ir � �'� / •� �"� 4�®'�.�t �• '� •� �'�' <br />,✓'`�'� � .sue. -�"`" �,.�� �✓" ,s�.- <br />