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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE -7- t Y- 2-5- <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />[lick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fe <br />Name: E. I�wt <br />J <br />Long Pull Fi <br />Address: <br />(.�- ? Z <br />� <br />City/State/Zip: <br />Other Repa <br />c �y <br />�-2- <br />Total Cost ck� <br />Payment Method: <br />El Check ❑ Cash ❑ Credit <br />Tank (check if presen <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />designed operating depth <br />designed operating depth <br />structurally unsound <br />Septic/holding Tank #1 <br />❑ Yes 1:111W <br />❑ Yes <br />0•1q_0_ <br />❑ Yes Colo <br />Gallons:L9-->-O <br />Septic/holding Tank #2 <br />❑ Yes No <br />❑ Yes <br />0-N-o <br />❑ Yes Foo <br />Gallons: L J.Jv <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />13*9'ump Tank <br />❑ Yes No <br />❑ Yes <br />No <br />❑ Yes <br />Gallons: tbib C, <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenann Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes ❑ No <br />® -Yes ❑ No�^�� <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />acked tanks, missing baffles, broken covers, etc.? If so, explain in comments W. <br />,pr <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes No <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: and Application: ❑ Wastewater Treatment Plant <br />Disposal Site: ti <br />Lime: <br />Gallons ?,1 ) <br />Plowed: ❑ Yes No <br />Time: fo3g <br />Temperature: Z 1, Y <br />pH: I Z,_ t > 12 Ell <br />Time: <br />Temperature: Z Z-L <br />pH: ( Z._ ( > 12 <br />R-5 a <br />ILI oil <br />'44 <br />"M <br />IW47 <br />