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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE (=Z-7- zS' <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@ centurylink.net <br />Pumpin "--• J- - _ <br />Long P <br />Other F <br />_ <br />Name: <br />lilt V Vlv. r_ <br />Address: <br />12 coo <br />City/State/Zip: <br />Y\&o t.w.� <br />C� <br />Total C#-� <br />Payment Method: <br />heck ❑ Cash <br />❑ Credit <br />Q_ Coo <br />Tank leaks above the <br />designed operating depth <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />structurally unsound <br />ank leaks below the <br />Tank (check if presen <br />designed operating depth <br />❑ Septic/holding Tank #1 <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Septic/holding Tank #2 <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pump Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />How Accessed: ❑ Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ Yes ❑ No ❑ Yes ❑ No ���ct� /Vo t <br />t.vayi'G ,� <br />y­ «cn—y- any operaaonat issues or un.sare conamons wniie assessing the sewage tanks in this system, i.e., Q <br />cracked tanks, missina baffles. brnkpn rnvprs_ ptr 2 Tf cn_ pYniain in rnmmonte hoI nAl <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 />❑ Mound <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: rA �r m� Lsi,4e_r Ao, q c.e-e- sS <br />u.►^, .� t,a �- i � t-.J i,ti�n l�,fci(.�r �- u. <br />rJt,, <br />Disposal: ❑ Land Application: PKNastewater Treatment Plant L/";,W4PW'k <br />Disposal Site: <br />Lime: <br />Gallons 7" <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 0 <br />