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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE <br />Maintenance Inspection Form <br />MZim <br />Lic. #L4286 <br />Maintainer <br />Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOIrF <br />Pumping Fee: <br />Name: P <br />Long Pull Fee: <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Servio <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />— _`,m7uaKs o Ow the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if presew- <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally <br />unsound <br />eptic/holding Tank #1 <br />No <br />Gallo . ( � <br />ElYes No <br />❑ Yes C�' o <br />ElYes <br />Septic/holding Tank #2 <br />Yes <br />i No <br />Gallons: �� C✓L <br />❑ Yes No <br />❑ Yes C-No <br />❑ <br />E <br />❑ Pretr atment Tank <br />Ga <br />El Yes El No <br />❑Yes ❑ No <br />❑Yes <br />❑ No <br />s: <br />❑ Pump Tank <br />Gallons: <br />El Yes No <br />El Yes ❑�� <br />El Yes <br />❑IAd� <br />(�� <br />How Accessed:;Maintenance Hole <br />Scum/Sludge Measu/reds <br />Maintenance Holes Securely Replaced: <br />Reason ForPumping: <br />❑ Other (see attached) <br />El Yes C3 No <br />Yes ❑ No <br />-- <br />Did you identify an perational issues or unsafe conditions i e assessing the sewage tanks in this system, i.e., <br />ked tanks, missino baffles, broken rs, etc.? Ifso, explain in -bero <br />Tank #1 ❑ Yes P9,510 <br />Tank #2 ❑ Yes EMo <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: ❑ Land Application: Z Wastewater Treatment Plant WA <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />