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✓rrir crc"Jur <br />�� <br />7 �.k_ <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St_ Michael, MN 55376 <br />Maintenance lnspoction Form <br />MPCA Lit,. 19 t:,17,4 <br />Mwntainer Q JIm <br />Duane <br />N-ick <br />Phone. 763-497-2764 l <br />• Email: duanesepticCcenturylink_net <br />tnrvnInr- <br />DATE - Z /- C- <br />Name: <br />Pumping Fee: ; <br />Address: <br />airs: 4 <br />' <br />City/State/Zip: <br />pLonFee' <br />Payment Method: <br />❑ Check <br />❑ Cash <br />❑ Credit <br />f Service: <br />- - <br />- <br />Maintenance hole cover is dam7aged <br />Tank leaks below the <br />Tank leaks above the <br />cracked, unsecured, or appear <br />Tank (check if present) <br />designed operating depth <br />designed operating <br />depth <br />structurally <br />unsound <br />0-Septic/holding Tank #1 <br />❑ Yes Ca -No <br />❑ Yes <br />❑—No <br />❑ Yes <br />❑- Nlo <br />Gallons: <br />❑ Septic/holdng Tank #2 <br />El Yes �o <br />❑ Yes <br />0—No <br />❑ Yes <br />D—No <br />Gallons: <br />❑ Pretreatment Tank <br />O Yes O No <br />0 Yes <br />n No <br />fl Yes <br />G Zyo <br />Gallons: <br />G'PumP Tank <br />O Yes t7�lo <br />Ej Yes <br />s�o <br />Q 'Yes <br />Gallons: <br />HowAccessed.0a_tntenance Hole ScumiSludge Measured Maintenance Holes Securely Replaced: Reason Fov Pumping: <br />❑Other (see attached) ❑ Yes 2-No D-Yes ❑ 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, broken covers, etc.? If so, explain in comments below. <br />rank m1 ❑ Yes 0-No I Tank #2 ❑ Yes 0-No Pump Tank ❑ Yes ErNo 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/Surtacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Tients: <br />a/ Site <br />Disposal: <br />Lime: <br />❑ Land Application: ❑ Wastewater Treatment Plant <br />Gallons <br />Temperature: <br />Temperature: <br />Plowed. ❑ Yes <br />pH: <br />pH: <br />F <br />