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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE (�C-3v•—%� <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />0 Nic <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Long Pull Fee: <br />Other Repairs: <br />Name: �f r <br />I ay <br />IIY Y VI</G <br />Address: <br />130b J)ror,�6 �,kS <br />pr, <br />City/State/Zip: <br />(pro V16 <br />Total Cost of Sery <br />Payment Method: ❑ Check <br />❑ Cash <br />❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />Maintenance hole cover is damaged, <br />, crackedunsecured, or appears to be <br />structurally unsound <br />Septic/holding Tank #1 <br />Gallons: Zb <br />❑ Yes No <br />ElYes o <br />❑ Yes <br />/ <br />2—NO <br />ff-Septic/holding Tank #2 <br />Gallons: 5Dd <br />❑ Yes 'CoET <br />❑ Yes o <br />❑ Yes <br />No <br />❑ Pretreatment Tank <br />Gallons: <br />LQ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Pump Tank <br />Gallons: Svv <br />❑Yes o <br />❑ Yes o <br />❑ Yes <br />o <br />How Accessed: ErMaintenance Hole Scum/Sludge Measured aint7_�� <br />ecurely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ Yes No ❑ No <br />Didyou identify an ational issues or unsafe conditions w ssessing the sewage tanks in this i.e., <br />ed tanks. missino baffles. bmkan rn etc 7 Tf cn. aYnlain in rnm-f•c h <br />Tank #1 ❑ Yes ZrNo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <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: __'J�fwastewater Treatment Plant ' (,) <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />.✓�-� � sue. -�-- ,✓~''�-� �.'" s�.- <br />