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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE ( , -i(„ - 2.� <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />Log WNick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Name: c_'LL � IN V VIVC <br />- <br />IEvr1 % <br />Long Pull Fee: <br />Address: <br />r� <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of S� <br />Payment Method: Check ❑ Cash ❑ Credit <br />v <br />70 <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 />cracked, unsecured, or appears to be <br />structural) unsound <br />[;, eptic/holding Tank #1 <br />❑Yes <br />Gallons: t 2 <br />❑'No <br />El Yes �o <br />❑Yes C�J'No <br />Septic/holding Tank #2 <br />Gallons: 1 e J� <br />/ <br />❑Yes 0 No <br />❑ Yes R_1q_0 <br />❑ Yes Ef No <br />❑ Pretreatment Tank <br />Gallons: <br />ElYes ElNo <br />ElYes ❑ No <br />❑ Yes ❑ No <br />dPump Tank <br />Gallons: t iS--) <br />❑ Yes 2 No <br />❑ Yes n- No <br />❑ Yes 2r-'No <br />How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) O'Yes ❑ No E Yes ❑ No me;_ 4- <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br />cracked tanks. missino hafflac_ hrnlean rnvarc otr 7 rf cn ovnl�ln in <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes ffT No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ErMound <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: D<Vastewater Treatment Plant a,,e.4 'v� <br />Disposal Site: <br />Lime: <br />Gallons 2 3 AD <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />RUN`P J, , �'`•'� <br />