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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATF 3 - f 5 ' Li <br />Maintenance Inspection Form <br />MMP/CA Lic. #L4286 <br />Maintainer nn <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />Pumping Fee: <br />qtQ <br />�U�� <br />Name: g <br />i'NVUICE <br />Long Pull Fee: <br />1'1 ii�U� <br />Address: <br />` <br />�1 1 �t/s1'' / ✓�� � iiil <br />Other Repairs: <br />City/State/Zip- <br />Total Cost of Servic <br />Payment Method: ❑ Check ❑ Cash <br />;P�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/holding Tank #1 <br />❑ Yes <br />Gallons: <br />❑ Yes lo <br />❑ Yes <br />C10 <br />®tic/holding Tank #2 <br />❑ Yes <br />to <br />Gallons: 0�31D <br />❑ Yes 2 No <br />❑ Yes <br />Cyr <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />, mp Tank <br />Gallons: 500 <br />❑ Yes <br />EY,<o <br />� <br />El Yes 20'No <br />❑ Yes <br />/ <br />.0-No <br />How Accessed: 2r2aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Secure) Replaced: <br />Y p <br />Reason For.Pum m <br />Pumping: <br />❑ Other (see attached) <br />� <br />❑ Yes -F! <br />s ❑ No <br />'� I I" <br />Did you identify any operational r'ssues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks- miccinn haffloc hr Lb n IF, � Ta. <br />Tank #1 El Yes o <br />- <br />Tank #2 ❑ Yes o <br />- - --.-..r._................... �,�... <br />Pump Tank El Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />Ciegound <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 />vvn u i ic, i w. <br />Disposal: _171-Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: <br />❑Yes ❑ No <br />rime: i.l t� <br />Temperature: _ <br />—[ <br />pH: <br />> 12 ❑ <br />rime: = <br />Temperature: <br />pH: <br />> 12 0 <br />