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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />BATF 1 1— t a ---7 t <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />O Duane <br />-Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Name: <br />❑ Other (see attached) <br />❑ Yes ©HIT6 <br />.J �� cry <br />M Ct ^L 14 <br />C .- ryl A �' <br />c V\ ✓1 <br />❑ Risers leaking <br />Long Pull Fee: <br />❑ Baffles <br />❑ Baffles <br />Address::/ <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />ZrJ (,- C �L-(e-.r� <br />h,. %A V, <br />❑ Non-domestic waste <br />Other Repairs: <br />City/State/Zip: <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />/ <br />6 �'YN� <br />Total Cost of Servicer <br />�C 4� <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />( 3 <br />Z S— <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />designed operating depth <br />designed operating depth <br />, crackedunsecured, or appears to be, <br />structural) <br />unsound <br />❑optic/holding Tank #1 <br />-0 <br />-No <br />Gallons: t ZS <br />❑ Yes <br />S- <br />❑ Yes Er <br />❑ Yes <br />C -}—No <br />C9-Septic/holding Tank #2 <br />❑Yes <br />❑Yes C]—No <br />❑Yes <br />L�'h7o <br />Gallons: ,� <br />iZJ <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />dump Tank <br />D Yes <br />fo <br />❑Yes C—f�10 <br />❑Yes <br />Cd'iVo <br />Gallons: t Zs� <br />How Accessed: EMaintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes ©HIT6 <br />Q-'�,es ❑ No <br />M Ct ^L 14 <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks, missina baffles, broken covers, etc.? if so, explain in comments below. <br />Tank #1 ❑ Yes o <br />Tank #2 El 9,No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <br />E] 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 <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />>12 ❑ <br />Time: <br />Temperature: <br />pH: <br />>12 ❑ <br />• I► r� ` / ,moi Q� :. ' • " � ._R • �.�.� <br />