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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />neTF r-7- � Z_!r <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duanesepticCcenturylink.net <br />INVOICE <br />Pumping Fee: <br />Name: R-,�c <br />Address: <br />`� 5 <br />Long Pull Fee: <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Se ry c <br />14AAy� �, <br />Payment Method: ElCheck El Cash <br />❑ Credit <br />i�- <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />leaks below the <br />Tank (check if p <br />d operating depth <br />designed operating depth <br />structural) unsound <br />Septic/holding Tank #1 <br />❑ Yes D11<0 <br />❑ Yes <br />C No <br />❑ Yes <br />No <br />Gallons: l e,va <br />E?'Septic/holding Tank #2 <br />No <br />❑ Yes <br />0 No <br />Gallons: <br />❑ Yes Z/No <br />❑ Yes <br />❑ Pretreatment Tank <br />❑Yes ElNo <br />El Yes <br />❑ No <br />❑Yes <br />❑ No <br />Gallons: <br />Pump Tank <br />El Yes 0 No <br />El Yes <br />El No <br />❑ Yes <br />�o <br />Gallons: 1.�� <br />How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) f Yes El No C�7'Yes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br />r�rL 4 t—Lc miccin h,fflac hrnitan rnverc. etr.77fso. explain in comments -below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes ONo <br />Pump Tank El Yes ZINo <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: L''I 5 � / c,.r�i � -� $ Y5 -2 <br />Disposal: Ear` d Application: ❑ Wastewater Treatment Plant <br />Disposal Site: C Lime: Gallons i 1 Plowed: ❑ Yes No <br />Time: t_" 2 TemperaturpH: Z_ 3 > 12 � <br />Time: ® 3 q Temperature: k `�. pH: t Z- 2, > 12 D-l' <br />