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I <br />Ma►ntone,ncv <br />\ns� Poct►oh Forrc� <br />Septic Service, LLC <br />N1AIn1a�n��r , <br />1 -Jim <br />1205 LaBeaux Ave NE <br />t►tck <br />St. Michael, MN 55376 <br />• Phone: 763.gp7_ � A zam <br />DATE I( '9D - 7 S <br />27gq <br />• Email: duanesep%,,,@, stun/\tnk.r,a► <br />Pumping Fee: <br />d <br />Long Pull Fee: <br />Name: -- <br />S $:� <br />M <br />Address: <br />Other Repairs: <br />�> <br />C. 4 <br />iI <br />City/State/Zip: <br />Total Cost of Servic <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank (check if presen <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover Is damaged, <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />0"Septic/holding Tank #1 <br />structurally unsound <br />Gallons: - - <br />❑ Yes <br />a No <br />❑ Yes C1—No <br />❑ Yes tTNo <br />❑ Septic/holding Tank #2 <br />Gallons: — - % <br />❑ Yes <br />C1 No <br />❑ Yes C�10 <br />❑ Yes C_No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />O H0 <br />-! < , 0 NO O Ye No <br />Q Pump Tank <br />❑ Yes <br />! N, <br />U fes C3�IVo Yes d�►o <br />Gallons: , <br />ReaeonFor Pump�ra <br />DO 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 />Tank #1 ❑ Yes i] No Tank #2 ❑ Yes ONo Pump Tank ❑ Yes 0-No System <br />❑ Structural integrity ❑ Structural integrity ❑ Structural integrity Mound <br />❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑Elevated dralntleld <br />❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed <br />Cl Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches <br />❑ Non -domestic waste 1- ❑ PondinglSuriacing <br />❑ Effluent Filter/screen ❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal Site: <br />Time: <br />Time: <br />Disposal: ❑ Land Application: ❑ Wastewater Treatment Plant <br />Lime: Gallons <br />Temperature: <br />Temperature: <br />Plowed: ❑ Yes <br />PH: <br />pH. <br />