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II-�I Ei �it� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />®ATIE J-2S-7i <br />�on ea nc- Inspection Form <br />Maintainer Jim <br />(Vick <br />�= Sam <br />Phone: 763-497-2764 <br />Email: duaneseptic9centurylink.net <br />Pumping Fee: <br />Name: <br />lI�iVUtt;� <br />i. <br />Long Pull Fee: <br />/ <br />_ <br />Address: <br />Other Repairs: <br />Z f� <br />City/State/Zip: <br />U 0 <br />Total Cost of Service: <br />COur t= <br />t4 <br />Payment Method: <br />❑ Check <br />❑ Cash <br />❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above <br />the <br />Maintenance hole <br />cover is damaged, <br />designed <br />operating depth <br />designed operating <br />depth <br />cracked, unsecured, <br />or appears to be <br />structurally <br />unsound <br />❑ Septic/holding Tank #1 <br />Gallons: 10 <br />❑ Yes <br />❑ <br />No <br />❑ Yes <br />❑ <br />No <br />❑ Yes <br />❑ No <br />❑ Septic/holding Tank #2 <br />Gallons: ! .; <, <br />❑ Yes <br />El <br />No <br />❑ Yes <br />❑ <br />"No <br />❑ Yes <br />❑ "No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ <br />No <br />❑ Yes <br />❑ <br />No <br />❑ Yes <br />❑ No <br />❑ Pump Tank <br />Gallons: 1 ` S = <br />❑ Yes <br />❑ <br />No <br />❑ Yes <br />0 <br />'No <br />❑ Yes <br />❑- No <br />How Accessed: ❑Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ Yes ❑ No ❑"Yes ❑ No !!ln lcn - <br />Did <br />you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks. missino baffles. hmkan rn varc orr rf ov imrn in <br />Tank #1 <br />❑Yes ❑'No <br />Tank #2 El Yes ❑ No <br />Pump Tank El Yes ❑ No <br />System <br />❑ <br />Structural integrity <br />❑Structural <br />integrity <br />❑ Structural integrity <br />❑ <br />Mound <br />❑ <br />Risers leaking <br />❑ <br />Risers leaking <br />❑ Risers leaking <br />❑ <br />Elevated drainfield <br />❑ <br />Baffles <br />❑ <br />Baffles <br />❑ Baffles <br />❑ <br />Pressure bed <br />❑ <br />Non -domestic waste <br />❑ <br />Non -domestic waste <br />❑ Electrical issues <br />❑ <br />Trenches <br />❑ Non -domestic waste <br />❑ <br />Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ <br />Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑Land Application: El Wastewater Treatment Plant <br />Disposal Site: Lime: Gallons Plowed: ❑Yes ❑ No <br />Time: Temperature: pH: > 12 Li <br />Time: Temperature: pH: > 12 0 <br />