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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 9-- c'N Z-r <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee. <br />Name: <br />Address: 3 ti /� ± I <br />Long Pull Fee: <br />Other Repairs: <br />City/State/Zip: <br />Lov, , Lk .P <br />Qr <br />Total Cost of S <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />low the <br />Tank (che <br />ing depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) <br />unsound <br />tic/holding Tank #1 <br />Gallons: to -a <br />El Yes grlQo <br />❑Yes C3—roo <br />El Yes <br />�eptic/holding Tank #2 <br />Yes <br />Gallons: s—a-o <br />❑ Yes Z No <br />❑ Yes E-_ <br />❑ <br />2_1�0 <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑-Kmp Tank <br />�) / <br />❑Yes <br />No <br />Gallons �v <br />El Yes No <br />El Yes No <br />How Accessed: Maintenance Hole <br />Scum/SSl ge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />CJ Yes ❑ No <br />( ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />-cracked tanks. missino baffles, broken covers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes ElNo <br />Pump Tank ❑ Yes o <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: ❑ Land Application: Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons 2!,*_0 <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 0 <br />