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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE (' - 2 -7 - Z., <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Click <br />= Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: ' <br />Name: <br />uvvv�t.t <br />Long Pull Fee: <br />Address: <br />Z t G 5- <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of SeR <br />Payment Method: Check ❑ Cash <br />❑ Credit <br />Q i <br />Tank (check if presen <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) <br />unsound <br />L�'S`eptic/holding Tank #1 <br />Gallons: 9--o <br />ID Yes B"No <br />�^ <br />El Yes ❑ No <br />❑ Yes <br />,0-Tro— <br />E?Ieptic/holding Tank #2 <br />❑Yes Cn'No <br />6--No <br />Gallons: L o-o-9 <br />❑ Yes <br />❑ Yes <br />Eii_ o <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Pump Tank <br />Gallons: �q pa <br />^ � <br />❑Yes of <br />El Yes No <br />El Yes <br />_ �- <br />�' No <br />How Accessed: aintenance Hole <br />Scum/sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />ElOther (see attached) <br />Yes ElNo <br />C1-'es ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />wracked tanks, missino baffles. hrnken rnLarc atr 7 Tf cm Avnlaln in ­.., t' I—]—, <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes ZNo <br />Pump Tank ❑ Yes EfrNo <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />EIMound <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 k,,,� <br />Disposal Site: <br />Lime: <br />Gallons Z 2,O <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />• o, Q. i• • <br />M <br />• .� <br />