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ouANE*� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE % 0 - (7 - a <br />Maintenance Inspection Form <br />MP Lic. #L4286 <br />Maintainer Jim <br />Nick <br />Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: / t <br />VVIZvi <br />Address: <br />Long Pull Fee: <br />Other Repairs: <br />City/State/Zip: <br />-�� D <br />Total Cost of Serv�¢ <br />J <br />Payment Method: ❑ Check ElCash ❑ Credit <br />Tank leaks above the <br />Maintenance hole cover Is damaged, <br />Tank leaks below the <br />Tank (check if pre; <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />optic/holding Tank #1 <br />❑ Yes <br />eNo <br />El Yes No <br />El Yes ❑ No <br />Gallons: <br />optic/holding Tank #2 <br />'Co <br />Gallons: <br />❑ Yes <br />❑ Yes No <br />❑ Yes V'No <br />❑ Pretr atment Tank <br />❑Yes <br />❑ No <br />❑Yes ❑ No <br />❑Yes ❑ No <br />Gall s: <br />Pump Tank <br />❑ Yes <br />No <br />❑ Yes o <br />❑ Yes ❑ No <br />Gallons: <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason F Pumping: <br />❑ Other (see attached) <br />El Yes 11 No <br />es ❑ No <br />Did you Identify any operational Issues or unsafe conditions w -assessing the sewage tanks In this system, i.e„ <br />cLaekcfd tanks, missing baffles, broken co , etc.7 If so, explain In comments b� <br />Tank #1 ❑ Yes Pflo <br />Tank #2 ❑ Yes EWo <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural Integrity <br />Mound <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 />❑ Pond! ng/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: _--M-Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: V t <br />Lime: <br />Gallons <br />`,�� <br />Plowed: ❑ Yes <br />--ErN <br />Time: I I 5 t <br />Temperature: <br />(, Z <br />pH: t z, <br />> 12 ❑ <br />Time: t O I- <br />Temperature: <br />pH: t -?_ �" <br />> 12 0 <br />