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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 7 <br />Maintenance Inspection Form <br />Z�MA Lic. # 654 <br />Maintainer <br />D Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />IAI\/f\If%M <br />Pumping Fee: <br />Scum/Sludge Measured <br />Name: <br />Reason For P mping: <br />❑ Other (see attached) <br />❑ Yes 14 d <br />If r �es ❑ No <br />.� <br />�C <br />„t.('� D Its <br />i <br />�;•� �, <br />Long Pull Fee: a-� <br />❑ Baffles <br />t <br />Address: 33('r. �Yi c �. <br />r l i x c. <br />Other Repairs: <br />❑ Non-domestic waste <br />City/State/Zip:: <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />Total Cost of Servic �7 <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Comments: <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 depth <br />structural) unsound <br />eptic/holding k #1 <br />Gallons: 05 <br />❑ Yes No <br />❑ Yes 0-K-0— <br />❑ Yes <br />❑" o _ <br />R"5eptic/hong nk #2 <br />G <br />Gallons:/ <br />❑ Yes C1'No <br />❑Yes 9_1z_9_1z_ <br />❑Yes <br />f�-IVo <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ NooEIYes <br />❑ No <br />ump Tan <br />❑Yes �L'i No <br />❑ Yes Q'No <br />El Yes <br />Gallons: <br />How Accessed. -Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For P mping: <br />❑ Other (see attached) <br />❑ Yes 14 d <br />If r �es ❑ No <br />.� <br />Did you Identify any perational Issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cra�tanks, missing baffles, broken coversretc:7 If so, exolaln In comments below_. <br />Tank #1 ❑ Yes Wo <br />Tank #2 ❑ Yes E?Iqo <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />eIVIound <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: Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: 'i <br />cam' <br />Lime: ✓ Gallons Z.p r_, <br />Plowed: ❑ Yes <br />❑ No <br />Time: t . i <br />Temperature: -I , <br />pH: j? . <br />> 12•-E❑ <br />Time: 1 t� ,-, <br />Temperature: -11 <br />pH: 1 <br />> 12 ❑ <br />M <br />M�11 VQ "1110070, k' ...� <br />