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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 9" Z -3 - ?-.!,' <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer = Jim <br />"Nick <br />= Sam <br />® Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />iNvnir_F <br />Pumping Fee: <br />Name: <br />I / <br />Long Pull Fee: <br />t <br />Address: 1 2c> <br />i <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of S <br />Payment Method: <br />❑ Check ❑ Cash ❑ Credit <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank chec 3 below the <br />--"erating depth <br />designed operating <br />depth <br />cracked, unsecured, or appears to be <br />structurally unsound <br />eptic/holding Tank #1 <br />Gall - <br />❑ Yes _R1,_No� <br />❑ Yes <br />loj_fQo <br />❑ Yes _;oi�o <br />s: Lmr, <br />Septic/holding Tank #2 <br />El Yes CST No <br />Gallons: ,�-�% <br />❑ Yes <br />la o <br />❑ Yes ❑'No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />CKump Tank <br />El Yes (7'No <br />El <br />Gallons: Ly.�-0 <br />Yes <br />No <br />ElNo <br />Yes <br />How Accessed: ❑` aintenance Hole <br />Scum/SSl dge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />J <br />?Yes El No <br />54es ❑ No <br />* <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks, missing baffles, brokeaxovers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes 2No <br />Pump Tank ❑ Yes o <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: ❑ Land Application: C?'g/astewater Treatment Plant L.-,z4-c,40G- 0 <br />Disposal Site: <br />Lime: <br />Gallons 2 3 -A-�2 <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />P W.NOV <br />WE <br />_ •� <br />��`-�-�- �`'� .sue. -.�-' ,�--�-•. M ;Qs4;1;j@ <br />