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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE r 2 "% 2 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer = Jim <br />1'Nick <br />= Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Name: <br />INVUlUE <br />Long Pull Fee: <br />Address: <br />zo eof <br />�c�✓ rti <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Servic <br />\ �/ <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />� aH <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if iks below the <br />operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Septic/holding Tank #1 <br />Gallons: ( D00 <br />❑ Yes C- No <br />❑ Yes ET-N—o <br />❑ Yes <br />C�Septic/holding Tank #2 <br />Gallons: ovo <br />❑ Yes d No <br />❑ Yes 2r1N'_o <br />❑ Yes 2_1go <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />CYfump Tank <br />� <br />El Yes ®'No <br />❑ Yes <br />Gallons: ��,� <br />No <br />❑ Yes 171No <br />How Accessed: El Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />ElZ Other (see attached) Yes ❑ No I CYYes ❑ No 1 M4 , , <br />Did you identify any operational issues or unsare conditions while assessing the sewage tanks in this system, i.e., <br />cracked tankc- miccinn hafni h-1— � .a arm 7 ra � .,.,,_:_ _ ,. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />RrMound <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 />Cl Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: C"Larid Application: ❑ Wastewater Treatment Plant <br />Disposal Site: l <br />Lime: <br />Gallons 2 wo <br />Plowed: <br />❑ Yes o <br />Time: j 1 D 1 <br />Temperature: <br />I L/ <br />pH: <br />( 2- 3 > 12 <br />Time: 1 f 5" 7 <br />Temperature: <br />I r U <br />pH: <br />+ Z > 12 <br />