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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE C q - 0 --( — Z 75 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick L <br />0 Sam <br />® Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />IIN1/r11rF <br />Pumping Fee: Z�C� <br />Name: //2 <br />Long Pull Fee: � <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />c <br />br_cw1-1 /\) I <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Total Cost of Service: <br />b <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />e gn <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally unsound <br />Septic/holding Tank #1 <br />Gallons: ��� <br />El Yes <br />I�o <br />^ <br />❑ Yes E;r o <br />❑ Yes 0—no <br />Septic/ olding Tank #2 <br />Gallons: 'I , 0`2 <br />❑ Yes <br />[:�/N o <br />❑ Yes /940 <br />ElYes No <br />❑ Pretreatment Tank <br />Gallons: <br />ElYes <br />ElNo <br />ElYes ❑ No <br />❑ Yes ❑ No <br />Pump Tank <br />❑ <br />'b <br />❑ <br />El No <br />Gallons: � � a <br />Yes <br />No <br />Yes No <br />Yes <br />How Accessed -.-.,^^aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />El Yes No <br />—e Yes El 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 comments below. <br />Tank #1 ❑ Yes 9<o <br />Tank #2 ❑ Yes E�l�o <br />Pump Tank ❑ Yes o <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 />❑ 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: -e�a nd Application: ❑ Wastewater Treatment Plant <br />Disposal Site: 'J `` <br />Lime: <br />Gallons <br />Plowed: ❑ Yes --❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: ! <: > 12 0 <br />