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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 9 - La - ZN <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />Flick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Name: <br />IIV V VIIiC <br />Long Pull Fee: <br />Z <br />i <br />�: <br />Address: <br />- <br />Los <br />t� <br />Z$go <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Servic <br />�'C'v,116 <br />Payment Method: ❑ Check ElCash <br />❑ Credit <br />II // <br />k o v` <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />designed <br />operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally <br />unsound <br />Septic/holding Tank #1 <br />Gallons: ©o 0 <br />❑ Yes <br />❑ Yes E!�N o <br />❑ Yes <br />l <br />Septic/holding Tank #2 <br />Gallons: jovO <br />El Yes <br />No <br />/ <br />El Yes ❑ No <br />❑ Yes <br />er—N—o <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />/Pump Tank <br />❑ Yes <br />No <br />� <br />❑ <br />� <br />Gallons: t 00 <br />Yes 0-No <br />❑ Yes <br />Z'No <br />How Accessed: Maintenance Hole Scum/Slu ge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) C�'Yes ❑ No 2- es ❑ No 1 01,% r 'AA - <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, I.e., <br />clacked tanks. missina baffles. broken mvers_ err. 7 rf cn_ aYnlaln in rnm mantic haImAl <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes 2rNo <br />Pump Tank ❑ Yes o <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: and Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons 2 <br />Plowed: <br />❑ Yes <br />3'No <br />Time: ssI <br />Temperature: l F°T <br />pH: <br />t Z_ z-Z <br />> 12 ET — <br />Time: (02,1 <br />Temperature: 00 <br />pH: <br />t 2- Z- <br />> 12 Ef <br />../�`•�-ti �•�'rsue,,, ..1--"`" ,..�.`'�-�, �'''i`� .sue. <br />