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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE / 1 ?,3 <br />Maintenance Inspection Form <br />�Jcim"Iic. #L4286 <br />Maintainer <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: > <br />�.5a� <br />C��cf��, <br />Name: <br />Long Pull Fee: <br />.37��� <br />v <br />Address: <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Servi <br />S74 5o _) <br />Payment Method: <br />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 />eptic/hold! Tank #1 <br />Gallons: fr <br />❑ Yes <br />C to <br />❑ Yes <br />ETIN o— <br />❑ Yes <br />1�ro` <br />Septic/hold! Tank #2 <br />Gallons jo U'd <br />❑Yes <br />❑Yes <br />No <br />❑Yes <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑,No- <br />El Yes <br />ElNo <br />❑ Yes <br />❑l No <br />Pump Tank <br />El Yes <br />el No <br />El Yes <br />❑ <br />rC] <br />Gallons: 5(dp <br />El Yes <br />No <br />How Accessed. aintenance Hole Scum/Sludge Measured <br />�-- Maintenance <br />--H`olles Securely Replaced: Reason For Pumping: <br />ElOther (see attached) ❑ Yes -41 reo ��'Yes ❑ No <br />u,o you ,aent,ry an -operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />eked tanks, missino baffles, broken covers —etc.? Tfsn. exnlain in rnmmPnhc hal, w <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes EFo <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />0 Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfleld <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 />❑ Pond! ng/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: -❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: E <br />Lime: _ <br />Gallons 1. _ .jt_, <br />Plowed: ❑ Yes -❑ No <br />Time: t <br />Temperature: <br />pH: > 12:-❑ <br />Time: 3, ; 5 . 5 <br />Temperature: y <br />pH: > 12 ❑ <br />