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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nATF = /f1-- ? Z <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer O Jim <br />Duane <br />CNick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />- <br />Pumping Fee: � 35.E � <br />Na e: <br />Pump Tank ❑ Yes Tmo <br />System <br />IIY V VI</G <br />❑ Structural integrity <br />❑ Structural integrity <br />a b, <br />Vic® <br />❑ Risers leaking <br />❑ Risers leaking <br />Long Pull Fee: <br />❑ Baffles <br />Address: <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />o.� <br />❑ Electrical issues <br />32 -o <br />-s- <br />4 tt <br />p_- <br />Other Repairs: <br />City/State/Zip: <br />Effluent FlltSrlgereen <br />❑ Other: <br />Cleaned? ZYes ❑ No <br />G`d thE} <br />Comments: Ct�s-rn �. t I-ev e✓Ar �j , �(. lam; II <br />S ra-� e_ . �� �S 5.� (;,/ 1-v�t 4-- :1 4- t ti..'T'+o --�� �l. �5. 1 7 0A (/ii}dt� p t C5 �,L.X 4-v et h <br />( JJd J— <br />/�h2P <br />At-LLA.Q 114_ h cle J <br />Total Cost of Service:c�v,� <br />Payment Method: <br />Check ❑ Cash <br />❑ Credit <br />Vo <br />3CP <br />3 go <br />Tank (check If present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />designed operating depth <br />designed operating <br />depth <br />cracked, unsecured, or appears to be <br />structural) <br />unsound <br />�c/holding Tank #1 <br />Gallons: 1 Z Z;—v <br />❑ Yes <br />❑ Yes <br />lti o <br />❑ Yes <br />B-tVo' <br />Septic/holding Tank #2 <br />Gallons: I Z.5 -D, <br />❑ Yes <br />Cr No <br />❑ Yes <br />aN�o <br />❑ Yes <br />B'ITo <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Tank <br />Gallons: <br />Gallons: t Z� <br />❑ Yes LI _ o <br />❑ Yes <br />Cil No <br />❑ Yes <br />�'No <br />-low Accessed: aintenance Hole Scum/Sludge MeasuredMaintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) CI Yes 041101,&-rees ❑ No 04 <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br />cracked tanks. missina baffles, broken covets. etr.7 rfsn. exnlaln In rnmmanhc halnul <br />Tank #1 ❑ Yes DW6 <br />Tank #2 ❑ Yes TGo <br />Pump Tank ❑ Yes Tmo <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <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 />❑ tJ domestic waste <br />❑ Ponding/Surfacing <br />Effluent FlltSrlgereen <br />❑ Other: <br />Cleaned? ZYes ❑ No <br />Comments: Ct�s-rn �. t I-ev e✓Ar �j , �(. lam; II <br />S ra-� e_ . �� �S 5.� (;,/ 1-v�t 4-- :1 4- t ti..'T'+o --�� �l. �5. 1 7 0A (/ii}dt� p t C5 �,L.X 4-v et h <br />( JJd J— <br />/�h2P <br />At-LLA.Q 114_ h cle J <br />Disposal: ❑ Land Application: 8'VVastewater Treatment Plant Wit ��, N 0 <br />Disposal Site: Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />rime: <br />Temperature: <br />pH: <br />>12 ❑ <br />rime: <br />Temperature: <br />pH: <br />> 12 ❑ <br />