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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 553f7,6 <br />1-DATE V) `2 <br />Maintenance Inspection Form <br />MP ALic. #L4286 <br />Maintainer Jim <br />0 Nick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: ----- <br />-- - L� <br />Name: <br />Long Pull Fee: <br />Address: IJ <br />31.E <br />C <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Service: <br />Check El Cash Credit <br />Tan < ea cs above the aintenance hole cover is damaged, <br />Tank leaks below t e _T <br />Tank (check if present) <br />designed operating depth <br />cracked, unsecured, or appears to be <br />designed operating depth <br />structural) unsound <br />Septic/holding Tank #1 <br />No <br />❑ Yes No <br />❑ Yes E3no <br />Gallons . <br />❑ Yes <br />Septic holding Tank #2 <br />Yes ❑ <br />Gallons: <br />❑ Yes 15 No <br />❑ Yes 2No <br />❑ <br />❑ Pretreatment Tank <br />G al to q,sz <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />ump Tank <br />Gallons: <br />❑ Yes ❑ o <br />❑Yes No <br />El Yes "v <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />aintenanncc �es Securely Replaced: <br />Reason F Pumping: <br />❑ Other (see attached) <br />❑ Yes No <br />�`❑ Yes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />5cked tanks. missing baffles. broken co tc.? Ifso, explain in comments be_s . , <br />Tank #1 ❑ Yes inNo <br />Tank #2 ❑ Yes o <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 />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: A-766? -.ZS 9' a b o <br />Disposal: ❑ Land Application: astewaterTreatment Plant <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 />,�„- �`'.sue. ,✓- � <br />