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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 1 1- (3- 7--SK- <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />1ntvn1r1` <br />Pumping Fee. <br />Name: <br />Long Pull Fee: <br />Address: <br />Other Repairs: <br />City/Sta <br />Total Cost of Serv' <br />Paymen e o K Check ❑ Cash <br />❑ Credit <br />�H <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />ow the <br />Tank (check if F <br />- ---- <br />__ ing depth <br />designed operating depth <br />structural) <br />unsound <br />eptic/holding Tank #1 <br />Gallons: 0 < <br />❑ Yes C3'Iq_o_ <br />❑ Yes 13_ 10 <br />❑ Yes <br />❑ Septic/holding Tank 12 <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ElNo <br />❑ Yes <br />❑ No <br />Q,P'ump Tank <br />jj <br />Gallons: L <br />❑ Yes !o No <br />❑ Yes a/No <br />❑ Yes <br />I <br />ssed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />r��ElOther (see attached) <br />hi Y/es ❑ No <br />Wres ❑ No <br />Ito -V L'_ �. _j- <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 vers, etc.? Ifso, explain in comments below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />and <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: 9 and Application: ❑ Wastewater Treatment Plant <br />Disposal Site: L'i <br />Lime: <br />Gallons 2 l a-O <br />Plowed: <br />❑ Yes <br />Ebb <br />Time: L. 3 v <br />Temperature: fq <br />pH: <br />_ q <br />> 12 -0— <br />Time: <br />Temperature: f 4, � <br />pH: <br />_ ' <br />> 12 <br />,_/'`�'� �`''� sue• .�','`'. ,✓'-'� �`'`� s�- <br />