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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 5-_y �LCt <br />Maintenance Inspection Form <br />MP Lic. #L4286 <br />Maintainer Jim <br />0 Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />I hiDbl Cad <br />Pumping Fee: <br />Name: <br />Long Pull Fee: <br />10. <br />Address: <br />�q0 <br />' <br />6rcl..c4- <br />joIL <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Ser <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />elow the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check ii <br />uG�iyi iCu operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Septic/holding Tank #1 <br />� <br />-r No <br />� <br />Yes No <br />Gallons: I Duo <br />El Yes �J No <br />❑ Yes <br />❑ <br />Z'Septic/holding Tank #2 <br />❑ Yes Z No <br />Gallons: 10,0 <br />❑ Yes Fl No <br />❑ Yes If No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Pump Tank <br />"No <br />�21' <br />Gallons: <br />ElYes <br />❑ Yes No <br />❑ Yes No <br />VA <br />How Accessed:ln Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes NCB" o <br />es ❑ No <br />/t✓f K <br />Did you identify��nny operational issues or unsafe condition .while assessing the sewage tanks in this system, i.e., <br />�CFacked tanks, missino baffles, broken c rs, etc.? If so, explain in comments bf4eTv. <br />Tank #1 ❑ Yes ZNo <br />Tank #2 ❑ Yes o <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: ❑ Land Application: !!!!�W_astewaterTreatment Plant �,� j y,'j�L-� <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />s�- <br />