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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE � 43 -_)Z57_ <br />Maintenance Inspection Form <br />MPC Lic. #L4286 <br />Maintainer Jim <br />0 Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVnIrF <br />Pumping Fee: 0 <br />Name: <br />LlmAI <br />Long Pull Fee: <br />Address: 7 <br />�`� '"'` <br />Other Repairs: <br />City/State/Zip: <br />C Pa” <br />Total Cost of Se <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />designed operating depth <br />designed operating depth <br />structurally <br />unsound <br />eSeptic/holdirm Tank #1 <br />Yes ❑ No <br />0 Yes � <br />❑ Yes <br />No <br />Gallons. <br />Septic/holding Tank #2 <br />Gallons: (6� <br />es ❑ No <br />❑ Yes .2- �o <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: ❑ M/aintteenance Hole <br />Other (see attached) <br />Scum/Sludge Measured <br />❑ Yes No <br />Maintenance Holes Securely Replaced: <br />eyes ❑ No <br />Reason r Pumping: <br />I <br />Did you identify y operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />racked tanks, missing baffles, broken s, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes ZNo <br />Tank #2 ❑ Yes n 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 />❑ Elevate ainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ P ure 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: IZWastewater Treatment Plant V" I.,.r—w V''­ <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 />