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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 1 JII-'Z7/ <br />Maintenance Inspection Form <br />MPJLA Lic. # 654 <br />Maintainer ��(JJiim <br />Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Scum/Sludge Measured <br />Oy , <br />l <br />�u� <br />11 Other (see attached) <br />Name: ! 1 C <br />hC l <br />9 s El No <br />�G <br />Long Pull Fee: 46 JL- <br />Sd <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />Address: <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 />Other Repairs: <br />❑ Effluent Filter/screen <br />City/State/Zip: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Total Cost of Servi <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <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 <br />depth <br />designed operating depth <br />structurally <br />unsound <br />antic/ho g�Tank #1 <br />❑Yes <br />No <br />Gallons: <br />❑Yes Com` <br />❑Yes <br />9-110--) <br />Septic/holdwin�g nk #2 <br />Gallons: l 24 v <br />❑ Yes <br />0 No <br />❑ Yes <br />❑ Yes <br />❑ Pretreatment Tank <br />J <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />RTIP'ump Tank <br />Gallons: 2 Jai <br />❑ Yes <br />-fl No <br />❑ Yes C I No <br />❑ Yes <br />4�,'�o <br />How Accessed -n Maintenance Hole <br />Scum/Sludge Measured <br />Maintenannce—Holes Securely Replaced: <br />Reason For P ping: <br />11 Other (see attached) <br />❑Yes 2'No <br />9 s El No <br />�G <br />Did you Identify an peratlonel issues or unsafe conditions while assessing the sewage tanks in this system,T_e_,, <br />eked tanks, missina baffles. broken covers. etr.7 rf cn. ernlaln In rnmmontc holnw <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes o <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 Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: _-Q-Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: q <br />Lime: j Gallons 0 o" <br />Plowed: ❑ Yes <br />❑ No <br />Time: C)o <br />Temperature: b Z, <br />pH: 12 ,' <br />> 12 ,CO <br />Time: �; -. �• :; <br />Temperature: :. <br />pH: ;. <br />> 12_.:0 <br />