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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE Si- -Z-2"3 <br />Maintenance Inspection Form <br />MPCAL4286 <br />Maintainer = Jim <br />Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />intvnirF: <br />Pumping Fee: <br />Name: ti <br />Long Pull Fee: <br />Address: <br />o <br />Other Repairs: <br />City/State/Zip: <br />pu-u '&'0 <br />Total Cost of Servi <br />�' <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 <br />depth <br />designed operating depth <br />structural) <br />unsound <br />ptic/holding Tank #1 <br />❑Yes <br />C�t-iVo <br />❑Yes No <br />❑Yes <br />No <br />Gallons: t Z Si? <br />Ej'geptic/holding Tank #2 <br />Yes <br />n <br />Gallons: I -a j)-v <br />❑ <br />No <br />❑ Yes No <br />❑ Yes <br />t=T No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />ump Tank <br />❑ Yes <br />l9' No <br />❑ Yes <br />❑ Yes <br />E;I_i oo <br />Gallons: 1 2 S-b <br />..01No <br />M <br />How Accessed. Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes ❑ o <br />❑ No <br />Ylst: 'r,� 4 - <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, 1. e., <br />-cracked tanks, missing baffles, broken covers, etc.? Ifso, explain In commentsbelow. <br />Tank #1 ❑ Yes 2rNo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural Integrity <br />ound <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: and Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: <br />❑ Yes ❑-N6 <br />Time: <br />3 -7 <br />Temperature: ) of <br />pH: <br />-a , 2-- > 12 <br />Time: <br />9 2 <br />Temperature: j <br />pH: <br />t Z, _2 > 12 El - <br />moor-_- sue. -�.'"`" ,.•�, .rr- sue,, <br />