710 North Shore Drive West - Septic Pumping Report

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Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE 5 - ` - Z-5' Maintenance Inspection Form MPCA Lic. #L4286 Maintainer 0 Jim 'Nick 0 Sam ® Phone: 763-497-2764 ® Email: duaneseptic@centurylink.net innintrc Pumping Fee: Name: d Long Pull Fee: Address: '7(0 tv? Other Repairs: City/State/Zip: Total Cost of Ser 14 Payment Method: ❑ Check ❑ Cash ❑ Credit Tank leaks above the Maintenance hole cover is damaged, cracked, unsecured, or appears to be elow the Tank (check if _ sting depth designed operating depth structural) unsound Septic/holding Tank #1 Gallons: ❑Yes El No ❑Yes El No El Yes El No Z'Septic/holding Tank #2 Gallons: t 9 ❑ Yes El No ❑Yes ❑ No El Yes El No ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Pump Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No How Accessed: Maintenance Hole cum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ElOther (see attached) rElYes ❑ No ❑ Yes ❑ No v e- Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., cracked tanks, missing baffles, broken covers, etc.? Ifso, explain in comments below. Tank #1 ❑ Yes ❑ No Tank #2 ❑ Yes ❑ No Pump Tank ❑ Yes ❑ No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ❑ Mound ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed ❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches ❑ Non -domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: ❑ Land Application: C2' I6Vastewater Treatment Plant Disposal Site: Lime: Gallons 11.00 Plowed: ❑ Yes ❑ No Time: Temperature: pH: > 12 ❑ Time: Temperature: pH: > 12 ❑ ,./''� � .sue.. �' ,✓�-� �`'�" sue.