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r <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN55376 <br />nATF 9.1j -.1 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />0 Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: j I <br />I e <br />Address: r-- <br />T <br />Long Pull Fee: <br />City/State/Zip: <br />Other Repairs: <br />C �J✓�� <br />Total Cost of SE <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (checl <br />rating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Septic/holding Tank #1 <br />I -L5D <br />El Yes No <br />❑Yes No <br />❑Yes <br />Gallons: <br />❑ Septic/holding Tank #2 <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />dump Tank <br />ElYes Z% No <br />❑ Yes lo/ <br />Gallons: %010 <br />ElYes No <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason Pumping: <br />El Other (see attached) <br />❑ Yes -1 No <br />DYe—s� ❑ No <br />lFpr <br />I 1 r <br />1 <br />Did you identl _,,'ny operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />ccracked tanks, missing baffles, broken covers etc. ? If so, explain in comments Frelow. <br />Tank #1 ❑ Yes CT No <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes -.No <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 <br />Plowed: ElYes ❑ No <br />Time: �� <br />Temperature: <br />pH: <br />Time: 9 S <br />Temperature: ; ; <br />pH: I < , < > 12 ❑ <br />