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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE `S—(q_ Z -L <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer = Jim <br />Duane <br />1PN ick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />I kiM.Tre-T=_ <br />Pumping Fee: .{ 350 a�0 <br />�I <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Name: <br />❑ Other (see attached) <br />❑ Yes Ift<0 <br />Iri�es ❑ No <br />r kc : A 4 <br />❑ Risers leaking <br />❑ Risers leaking <br />Y <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />Long Pull Fee:Address.. <br />3:5-, f0 <br />t2 ' <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />a <br />❑ Ponding/Surfacing <br />t Z70 <br />❑ Effluent Fllter/screen <br />❑ Other: <br />Other Repairs: <br />Cleaned? ❑ Yes ❑ No <br />City/State/Zip: <br />Comments: <br />�L <br />Total Cost of Service: <br />k <br />Payment Method: <br />Check <br />O Cash <br />O Credit <br />IZ-1 <br />z <br />3'8S <br />Tank (check if present) <br />Tank leaks below the <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 <br />depth <br />structural) <br />unsound <br />eptic/holding Tank #1 <br />Gallons: ,y, ->o <br />111 Yes <br />Ci�7o <br />[I Yes <br />r�'Ro <br />❑Yes <br />l <br />peptic/holding Tank #2 <br />Gallons: (�� <br />❑Yes <br />f�tdo <br />I-] Yes <br />2-9-0 <br />El Yes <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />I t Pump Tank <br />Gallons: (J <br />❑Yes <br />110 <br />❑Yes <br />O'No <br />CJ Yes <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes Ift<0 <br />Iri�es ❑ No <br />r kc : A 4 <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />cracked tanks, missing baffles, broken covers, etc.? Ifso, explain in comments below. <br />Tank #1 ❑ Yes ON o <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes ErNo <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 />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Fllter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />�L <br />Disposal: 3'Cand Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: -/ <br />Gallons Z_loo <br />Plowed: <br />❑ Yes <br />❑ No <br />Time: <br />Zl 1 <br />Temperature: <br />pH: <br />(2-,Y- <br />> 12 a' <br />Time: <br />Z Y <br />Temperature: I <br />pH: <br />t Z. S <br />> 12 E— <br />P. <br />. QW �114F.A091 25U. <br />