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Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE i I—'7-1,-2V Maintenance Inspection Form MPCA Lic. #L4286 Maintainer 0 Jim lick 0 Sam • Phone: 763-497-2764 • Email: duaneseptic9centurylink.net Pumping Fee. Name: v, —�-w v1 Long Pull Fee: Address: Other Repairs: City/State/Zip: Total Cost of Servic `C,,0 Payment Method: ❑ Check ❑ Cash ❑ Credit Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be Tank (check if pre:_. _ the -- depth designed operating depth structural unsound 2!16eptic/holding Tank #1 _ Gallons: El Yes F�lT0 El Yes ❑ El Yes �o Septic/holding Tank #2 ❑ Yes @� No Gallons: (S—�� El Yes No ❑ Yes ❑ No ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No LAmp Tank El Yes to El 'C] Gallons: �'� Yes l�No ❑ Yes No How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) Ca'Yes ❑ No es ❑ t Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., cracked tanks, missina baffles. broken anvers_ etr.7 rf sn_ exniain in rnmmantc 1-1-A/ Tank #1 ❑ Yes o Tank #2 ❑ Yes No Pump Tank ❑ Yes o System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity 4orMound ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed ❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches ❑ f Lon -domestic waste ❑ Ponding/Surfacing Effluent Filter/ creen ❑ Other: Cleaned? 2'Yes ❑ No Comments: Disposal: ❑ Land Application: EMTa`stewater Treatment Plant Disposal Site: Lime: Gallons.] Z� A Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 ❑