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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />nert` g- 12-2 _Z <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />Duane <br />.Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Ne/:�� <br />ason For Pumping: <br />❑Other (see attached <br />❑ Yes l�'(�o <br />�s ❑ No <br />O Risers leaking <br />❑ Risers leaking <br />Long Pull Fee: <br />75 do <br />❑ Elevated drainfield <br />Address: <br />33'7 <br />tt <br />❑ Baffles <br />Other Repairs: <br />❑ Non-domestic waste <br />City/State/Zip: <br />❑ Electrical issues <br />❑ Trenches <br />i <br />W �-� 40 W ,n <br />Li wt t�. ?� <br />Q� i'L-O <br />❑ Ponding/Surfacing <br />Total Cost of Service:ch <br />❑ Other: <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />y7D <br />Comments:, <br />omments:,bvK+ �5Q r (' 3(LIP 154- <br />bvK5 - <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 />2- eptic/holding Tank #1 <br />❑ Yes or -1, o <br />❑ Yes P-rqo-- <br />❑ Yes <br />No <br />Gallons: I LSb <br />holding Tank #2 <br />�- <br />❑Yes <br />Gallons: o <br />Gallons: <br />El Yes M No <br />❑ Yes ❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Ewi�umpTank <br />21- <br />Gallon <br />Gallons::� LSA <br />❑ Yes No <br />❑ Yes 0" No <br />❑ Yes <br />0 <br />How Accessed:D Maintenance HoleScum/Sludge <br />Measured <br />Maintenance Holes Securely Replaced:7n,) <br />ason For Pumping: <br />❑Other (see attached <br />❑ Yes l�'(�o <br />�s ❑ No <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 covers, etc.? If so, exolaln In comments below. <br />Tank #1 ❑ Yes o <br />Disposal: <br />Tank #2 ❑ Yes C No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity0-Mound <br />O 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 />omments:,bvK+ �5Q r (' 3(LIP 154- <br />bvK5 - <br />Disposal: U Lams MIJIJIIGattuf l: L= VVGJtGwaltli uCaunci n r unt -- • r-t>'iJ7 r <br />Disposal Site: Lime: Gallons Z SL-7LO Plowed: ❑ Yes <br />rime: Temperature: pH: >12 ❑ <br />Time: Temperature: pH: >12 0 <br />011, <br />59 <br />wo �- N <br />