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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE��- Z� <br />Maintenance Inspection Form <br />MPC�A Lic. #L4286 <br />Maintainer ® JJim <br />0 Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />imilrWIG <br />Pumping Fee: <br />;� 5ZIU <br />Name: <br />Long Pull Fee: <br />Address: .-- <br />317P <br />�� ` _ <br />Vl/.�4 t.:, 76 <br />Other Repairs: <br />City/State/Zip: <br />,i <br />G' <br />Total Cost of Si <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank (checl <br />ank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />igned operating depth <br />designed operating depth <br />structural) <br />unsound <br />Septic/holding Tank #1 <br />Gallons: <br />El Yes E. <br />^! <br />El Yes <br />❑ Yes <br />• t7 No <br />Septic/holding Tank #2 <br />Gallons: <br />❑ Yes No <br />❑ Yes _P_<0 <br />❑ Yes <br />C-No <br />❑ Pretreatment Tank <br />Gallo <br />ElYes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Pump Tank <br />,� <br />❑ Yes No <br />El <br />,/ <br />Gallons: <br />-e <br />Yes No <br />El Yes <br />_,rNo <br />i <br />How AccessedO Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />/ <br />El Yes r- No <br />-0'Yes ❑ No <br />Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />wed tanks, missing baffles, broken cars, etc.? Ifso, explain in comments below. <br />Tank #1 ❑ Yes gq4o <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <br />System . <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />Efr 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: ❑ Yes ❑ No <br />Time: : ;; <br />Temperature: — <br />pH: >,12 ❑ <br />Time: <br />Temperature: 1 • <br />pH: > 12 ❑ <br />PIP <br />r/A V <br />_j � .sue- ,✓'`�'� �' .sue <br />