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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />r%ATC C—_ 1 1, , 7 Sl <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />4TNick <br />= Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping FPp• ► <br />Name: 'FUi <br />Address: <br />t Z cl 0 <br />Long Pull F <br />� <br />City/State/Zip: <br />Other Repc <br />V-0iD <br />Total Cost 1 <br />, mar (� <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />ti d4 <br />Maintenance hole cover is damaged, <br />Tank (check if presen <br />ank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally <br />unsound <br />Q eptic/holding Tank #1 <br />❑ Yes 0-5-0— <br />❑ Yes <br />P—No <br />❑ Yes <br />0 to <br />G al-aJ lons:Lp <br />Ca'Sll�eptic/holding Tank #2 <br />El Yes C�" No <br />El Yes <br />C % <br />❑Yes <br />E� No <br />Gallons: Lc—9 , <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />Pump Tank <br />ElYes <br />L;1 <br />Gallons: � e � <br />❑ Yes Q40 <br />El Yes <br />No <br />-low Accessed: E3Maintenance Hole <br />Scum/Sludge Measured <br />oles Securely Replaced: <br />MaintenVes <br />Reason For Pumping: <br />El Other (see attached) <br />� Yes El No <br />❑ No <br />VW Ca.4 w <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />k,An ,, k , L—, oKi. ofr 7 rr cn arnlain in rnmmenf3 below. <br />Tank #1 ❑ Yes ffNo <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes 2TNo <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />2Mound <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: E5 Land Application: ❑ Wastewater Treatment Plant <br />disposal Site: �^� t Lime: Gallons 2- �.a Plowed: El Yes ON <br />time: Temperature: 1N t 3�t pH: t Z_C( > 12 <br />rime: 2 3 7 Temperature: 'Z'am ° L 3 pH: l2 > 12 <br />s�- <br />