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ovaNE*�, <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nnTE 9-(7- L/ <br />Maintenance Inspection Form <br />MP • A Lic. # 654 <br />MaintainerJim <br />[__1 Duane <br />= Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVO[CE <br />Pumping Fee: <br />Scum/Sludge Measured <br />❑ Yes ,0'No <br />Maintenance Holes Securely Replaced: <br />❑ 0--s ❑ No <br />Name: 1 �$ <br />❑ Structural integrity <br />Long Pull Fee: <br />❑ Structural integrity <br />PT Mound <br />Address; <br />—755.- urrr <br />'t• (2 d, <br />Other Repairs: <br />❑ Elevated dralnfield <br />Cl Baffles <br />City/State/Zip: <br />❑ Bellies <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestle waste <br />(� i^a V1 v <br />❑ Trenches <br />- <br />Total Cost of Service: <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />Payment Method: ❑ Check <br />❑ Cash ❑ Credit <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />'•'•.Riia kjit resent � �' <br />'; <br />' r` Tank leakstielowth�::v�• �,;. <br />,11' <br />�; f•r - <br />; ;Tanklaaksabove,the1 <br />`' depth?' <br />'..M�Iritonance,htile.coVef Is damaged, <br />a ,. <br />`Cracked; unsecdreSd, Rr.' appears to be. <br />ten r, r. f�' .' .+ <br />deslgned'oper <br />depth <br />_ <br />designe�:oparaQng <br />sl uolurai u 'sound <br />Septic/holding Tank #1 <br />❑ Yes <br />42- Co <br />❑ Yes 1 � <br />❑ Yes ®'No <br />Gallons: (2j't'� <br />Q- ptic/holding Tank #2 <br />/Z) <br />❑Yes <br />R--N--o <br />❑ Yes o <br />❑ Yes U.-1 <br />Gallons: <br />❑ Pretreatment Tank <br />Gallons: <br />Cl Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />tl-Aurnp Tank <br />Gallons: 12 Y <br />❑ Yes <br />.rte No <br />❑Yes No <br />EI Yes o <br />How Accessed: OWNIntenance Hole <br />❑ Other (see attached) <br />Scum/Sludge Measured <br />❑ Yes ,0'No <br />Maintenance Holes Securely Replaced: <br />❑ 0--s ❑ No <br />Reason For umping: <br />Did you Identify an�ry operational Issues or unsafe conditions while assessing the sewage tanks In this system, he', <br />mocked tanks, misslna baffles, broken covers, etc.? If so, exnlaln In comments below. <br />Tank #1 ❑ Yes ONo <br />Tank #2 ❑ Yes 94,No <br />Pump Tank ❑ Yes 1511NO <br />System <br />❑ Structural integrity <br />❑ Structural Integrity <br />❑ Structural integrity <br />PT Mound <br />l7 Risers leaking <br />❑ Risers leaking <br />❑ Rlsers leaking <br />❑ Elevated dralnfield <br />Cl Baffles <br />❑ Baffles <br />❑ Bellies <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestle 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: O Wastewater Treatment Plant <br />Asposal Site: Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />ime: <br />Temperature: <br />pH: <br />>12 ❑ <br />time; <br />Temperature: <br />pH: <br />>12 ❑ <br />�Q�® •�.-.�. Chir .r'� ' ���/ .� ..,..� <br />