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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 9 ;291 -,:?0 <br />Maintenance Inspection Form <br />MP Lic. # 654 <br />Maintainer Jim <br />D Duane <br />0 Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />rnninirU <br />Pumping Fee: <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Name: 1 fP <br />❑ Other (see attached) <br />JO <br />es ❑ No <br />we, C'/�- <br />❑ Elevated drainfield <br />❑ Baffles <br />Long Pull Fee: <br />❑ Pressure bed <br />❑ Non-domestic waste <br />Address: <br />a 90 Re-,, Tivcz ( E <br />Other Repairs: <br />City/State/Zip: <br />❑ Ponding/Surfacing <br />Total Cost of Service: <br />ss __,� <br />❑ Other: <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank (check It present) <br />Tankleaks below the <br />- <br />Tank leaks above the <br />Maintenance hole cover Is damaged, <br />cracked, unsecured, or appears to be <br />designed operating depth <br />designed operating; depth <br />structurally unsound <br />�eptic/holding Tank #1 <br />Gallons: / Z45 0 <br />❑ Yes <br />No <br />❑ Yes P"No <br />❑ Yes f7 No <br />eptic/holding Tank #2 <br />Gallons: Z, j—U <br />❑ Yes <br />Lel,.to <br />❑ Yes L�lo <br />❑ Yes B" No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />U-.Km'p Tank <br />_T_' <br />Gallons: i OLID <br />❑ Yes <br />�No <br />❑ Yes No <br />❑ Yes No <br />How Accessed: DVaintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For P mping: <br />❑ Other (see attached) <br />❑ Yes [�'No <br />es ❑ No <br />we, C'/�- <br />L� <br />Did you identify ny operational Issues or unsafe condition while assessing the sewage tank in this system, i.e., <br />�� racked tanks, misslno baffles, broken ers, etc.? If so, exofain In comment below. <br />Tank #1 ❑ Yes iff No <br />Tank #2 ❑ Yes OeNo Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity ❑ Structural integrity <br />Mound <br />O Risers leaking <br />❑ Risers leaking ❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles ❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste ❑ 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: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />cam' !" 1_ <br />