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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATF <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer 0 Jim <br />vane <br />0 Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />n iNvnirF <br />Pumping Fee: <br />6c) <br />Maintenance Holes Securely Replaced: <br />©'Yes ❑ No <br />Name: <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <br />O Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />Long Pull Fee: <br />, <br />❑ Pressure bed <br />Address: <br />❑ Non-domestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />Other Repairs: <br />City/State/Zip: <br />Comments: <br />Total Cost of Service: <br />G a <br />Payment Meth <br />❑ heck <br />❑ Cash <br />❑ Credit <br />2�� <br />L J -76 <br />a� f <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />designed operating depth <br />designed operating depth <br />cracked, <br />unsecured, or appears to be <br />structurally <br />unsound <br />11 Septic/holding Tank #1 <br />Gallons: <br />❑Yes <br />IIQ`o <br />ED Yes <br />�'FJo <br />❑Yes <br />CEJ—tV`o <br />E�'Septic/holding Tank #2 <br />o <br />Gallons: <br />❑ Yes <br />E"o <br />❑ YessR-No <br />❑ Yes <br />E - <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />p Tank <br />❑ Yes <br />©_<o <br />L1N <br />tlo <br />ElYes Yes <br />No <br />Gallons: <br />How Accessed: aintenance Hole <br />❑ Other (see attached) <br />�Scum/Sluclge Measured <br />❑ No <br />Maintenance Holes Securely Replaced: <br />©'Yes ❑ No <br />Reaso or Pumping: <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cracked tanks, missino baffles, broken covers, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes E -N -c <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <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 />Disposal: and Application: ❑ Wastewater Treatment Plant <br />Disposal Site: L--- Lime: _ Gallons �> 6 C Plowed: ❑ Yes O-nto <br />Time: e, Temperature: pH: 12- _,3 > 12 <br />Time: a - Temperature: Z pH: / 2 -3 > 12 ❑ <br />,_/�.'�, �✓� sem. -�-' ,.,/�'�-�, �'''�".s�- <br />