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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 6 )¢ <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />0 Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />11111//11 f+c <br />Pumping Fee: <br />j"_ <br />lT <br />Name: � <br />IIAV VI%. V_ <br />Long Pull Fee: <br />Other Repairs: <br />Address: ,-- <br />City/State/Zip: <br />Total Cost of Sere <br />Payment Method: ❑ Check <br />❑ Cash ❑ 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 />unsecured, or appears to be <br />cracked, structural) unsound <br />el"Septic/holding Tank #1 <br />Gallons: <br />❑ Yes 4'No <br />❑ Yes ❑ No <br />❑ Yes r No <br />eptic/holding Tank #2 <br />Gallons: <br />❑ Yes <br />❑ Yes_ <br />❑ Yes CN0 <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ Now <br />mp Tank <br />Gallons: <br />❑ Yes <br />❑ Yes E31 o <br />❑ Yes e No <br />How Adcessed: Maintenance Hole <br />Scum/Sludge M_easu/red _ <br />Maintenance Holes Securely Replaced: <br />Reason For umping: <br />❑ Other (see attached) <br />❑ Yes "❑ No <br />l�-` ss"� El No <br />1-1 <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, I.e., <br />crackg-d tanks, missing baffles, broken cetc.? If so, explain in comments beloQjac_.-- <br />Tank #1 ❑ Yes o <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: Wastewater Treatment Plant L14 (e,Ta_VK <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 0 <br />