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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 7- 7.2 _ Z 2 <br />Maintenance Inspection Form <br />MPCA Lie. # 654 <br />Maintainer Jim <br />Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />` intvnrr� <br />Pumping Fee: <br />3 70 ��,, <br />Scum/Sludge Measured <br />Name: <br />2D <br />Reason For Pumping: <br />❑ Other (see attached) <br />El Yes D<O <br />tis ❑ No <br />Vii• "V4— <br />❑ Risers leaking <br />❑ Risers leaking <br />Long Pull Fee: <br />❑ Baffles <br />❑ Baffles <br />Address: <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical Issues <br />❑ Trenches <br />/05-0 <br />Ftt r WN <br />❑ Non-domestic waste <br />Other Repairs: <br />City/State/Zip: <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Total Cost of Service: <br />�t..w k <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />0LA <br />Tank check if resent <br />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 <br />operating depth <br />designed operating depth <br />structural) <br />unsound <br />Septic/holding lank #1 <br />Gallons: t Z.., o <br />❑Yes <br />EI -M57 <br />❑ Yes 2 -Nu- <br />❑ Yes <br />❑� <br />Gallons: holding Tank #2 <br />Gallons: � <br />❑ Yes <br />0 -IN o <br />❑ Yes t�'No <br />❑ Yes <br />Z,.� � <br />❑ Pretreatment Tank <br />Gallons: <br />E)Yes <br />❑ No <br />❑ Yes ElNo <br />ElYes <br />ElNo <br />[3 -Pump Tank <br />❑ Yes <br />Cf <br />Gallons: t -Z S� <br />No <br />❑ Yes C3`No <br />❑Yes <br />E1 No <br />How Accessed: LWaintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />El Yes D<O <br />tis ❑ No <br />Vii• "V4— <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, exnlaln In comments below. <br />Tank #1 ❑ Yes ETNo <br />Tank #2 ❑ Yes El No <br />Pump Tank ❑ Yes ET No <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: <br />Disposal: ❑'Cnd Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons 2 <br />Plowed: ❑ Yes <br />-.«blo <br />lime: <br />Z <br />Temperature: Le <br />pH: f 2_:'3 <br />> 12 P- <br />rime: <br />10111 <br />Temperature: Gr t <br />pH: 2_1 <br />> 12 Cfi <br />