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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE %- ( (— 2-r <br />Maintenance Inspection (Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />ANick <br />0 Sam <br />hone: 763-497-2764 <br />® Email: duaneseptic@centurylink.net <br />MAIrUrrG <br />Pumping FeP• <br />Name: <br />S0G� <br />Long Pull Fe <br />Address: -6 U <br />S <br />Other Repair <br />City/State/Zip: <br />0� a <br />Total Cost of <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank (check if present) <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 <br />unsound <br />ErS'eptic/holding Tank #1 <br />Gallons: f-7s--p <br />❑ Yes RrITO <br />❑ Yes � <br />❑ Yes <br />❑�oN <br />12'9_e­ptic/holding Tank #2 <br />/ <br />El Yes fl <br />Yes ff -No <br />Yes <br />l <br />Gallons: o <br />No <br />❑ E <br />❑ <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑'6ump Tank <br />Gallons: t 2�� <br />El Yes ❑40 <br />El Yes No <br />El Yes <br />❑ No <br />How Accessed: OQaintenance Hole <br />ge Measured <br />ScumVes <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑'❑ No <br />C3'Yes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />_,eracked tanks, missing baffles, broken_eovers, etc.? Ifso, explain in comments -below. <br />Tank #1 ❑ Yes KNo <br />Tank #2 ❑ Yes El No <br />Pump Tank ❑ Yes ONo <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 />Cl Non -domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: PfLand Application: F/astewater Treatment Plant <br />Disposal Site: <br />Z <br />Lime: I---- <br />Gallons 2_�Vo <br />Plowed: <br />❑ Yes <br />--E!rN—o <br />Time: <br />a30 <br />Temperature: (qi 'o <br />pH: <br />L <br />> 12 El — <br />Time: <br />yJ c) <br />Temperature: <br />pH: <br />z; Z <br />> 12 0 <br />