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Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 l, DATE c �_ * V Maintenance Inspection Form MPCA Lic. #L4286 Maintainer ❑ Jim Nick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net IN1/r)IrF Pumping Fee: Name: Long Pull Fee: Address: f Other Repairs: City/State/Zip: Total Cost of Se ice: I au\ V Payment Method: ❑ Check ❑ Cash ❑ Credit `D� _ S ®1t Tank (check if presen Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be designed operating depth designed operating depth structural) unsound Septic/holding Tank #1 Gallons: to 0-0 ❑ Yes No ❑ Yes No ❑ Yes ❑ No Septic/holding Tank #2 Gallons: ❑ Yes No ❑ Yes e No ❑ Yes M No ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 71�ump Tank Gallons: lL7,�>d ❑ Yes ZINo ❑ Yes E:4-No ❑ Yes L_No How Accessed. Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: El Other (see attached) rrYes El No 2' s ❑ No Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., racked tanks, missing bafFles, broken c vers, etc.? If so, explain in commen elow. Tank #1 ❑ Yes No Tank #2 ❑ Yes o Pump Tank ❑ Yes No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ETMound ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed ❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches ❑ Non -domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: O'15and Application: ❑ Wastewater Treatment Plant Disposal Site: t/vt t Lime: Gallons z-fv-,) Plowed: ❑ Yes 2<0 Time: Lr Temperature: i q `7 pH: 2_ L > 12 Time: Temperature: ZO, 0 pH: t.y > 12 Fer