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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376/ <br />DATE cl -�yZY <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />lick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />WilrNifIc <br />Pumping Fee: <br />y�c Z <br />Name: <br />_ S�rV_ <br />s <br />toy a <br />Long Pull Fee: <br />Address: <br />7-S$0 Fix 5�- <br />Other Repairs: <br />City/State/Zip: <br />®WpVXi) <br />Total Cost of Service <br />— <br />Payment Method: GFCheck ❑ Cash <br />❑ Credit <br />o'u <br />qc, z 5v <br />Tank check if resent <br />p <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 <br />depth <br />designed operating depth <br />structural) <br />unsound <br />C�-tic/holding Tank #1 <br />Gallons: ( ZS-o <br />❑ Yes <br />❑lo <br />� <br />El Yes ❑ No <br />❑ Yes <br />Cf'Iq_o <br />Septic/holding Tank #2 <br />❑ Yes <br />No <br />❑ Yes <br />Gallons: t 2S-o <br />No <br />❑ Yes <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ NNoo <br />El Yes El No <br />El Yes <br />El No <br />Pump Tank <br />;�N�o <br />Gallons: I Z <br />❑Yes <br />C� <br />El <br />❑ Yes <br />❑._ doo <br />W <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />2- es El No <br />Cf"Yes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />_cracked tanks, missing baffles, broken covers, etc.? Ifso, explain in comment low. <br />Tank #1 ❑ Yes 2flo <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ �Mou�nd <br />ElRisers leaking <br />ElRisers leaking <br />❑ Risers leaking <br />Q 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: 2TWastewater Treatment Plant t ,11-4e- -'V t <br />Disposal Site: <br />Lime: <br />Gallons .3 e-s' 0 <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 0 <br />