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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE S 1 - -7- -S- <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />-Fo Nick <br />= Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: <br />Long Pull Fee: <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />1-Vv�_o <br />Total Cost of SE <br />4C <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />o ue <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />11 <br />ank leaks below the <br />Tank (chec <br />>lgned operating depth <br />designed operating depth <br />structurally <br />unsound <br />Septic/holding Tank #1 <br />Gall ns: t 2 S'"c <br />❑ Yes 0� <br />❑ Yes � <br />El Yes <br />�lo— <br />Septic/holding Tank #2 <br />ElYes 'No <br />Gallons: too <br />C <br />ElYes No <br />❑ Yes <br />2i.-No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />9,5rump Tank <br />� <br />El <br />Gallons: 12� <br />Yes ®'No <br />❑ Yes No <br />❑ Yes <br />LTl No <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />ElOther (see attached) <br />Comes ❑ No <br />Cd'1'es ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />,.,cracked tanks, missing baffles, brokeryeovers, etc.? If so, explain in comment low. <br />Tank #1 ❑ Yes ONo <br />Tank #2 ❑ Yes RT No <br />Pump Tank ❑ Yes C21NO <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: IT'VVastewater Treatment Plant LJ <br />Disposal Site: <br />Lime: <br />Gallons Z 3 --) <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 0 <br />