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N <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />neTF� <br />Maintenance Inspection Form <br />;MPCA ic. #L4286 <br />Maintainer m <br />Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name:< <br />Address: <br />r <br />Long Pull Fee: <br />0C r <br />Other Repairs: <br />City/State/Zip: <br />C) rvet D <br />Total Cost of Sere <br />Payment Method: ❑ Check <br />❑ Cash ❑ Credit <br />flow the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if <br />ing depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Septic/holding Tank #1 <br />1ii1 <br />�� <br />I--] Yes z;VNo <br />[I Yes � <br />El Yes No <br />Gallons: <br />Septic/holding Tank #2 <br />01,0 <br />❑ Yes C�No <br />❑ Yes E,;L_N,9 <br />❑ Yes <br />Gallons: t <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />�mp Tank <br />/� <br />Gallons: 69 <br />❑ Yes �No <br />El Yes ❑ Pdo <br />El Yes -� No <br />How Accessed:aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />' <br />El Yes 2 o <br />❑-'re ❑ No <br />(L' <br />Did you identify �y operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />rarkarl tankc_ missinn hafFla.s_ hrnken rov€rs, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes FANo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ ound <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: 2rWastewater Treatment Plant <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 />�.�•�� Vim`. �•�,,r�-�--�� .�"`r �..��, ,�✓'� �"s�- <br />