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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 1,9 ; � —7 - ) ct <br />Maintenance Inspection Form <br />;�C <br />. Lic. #L4286 <br />Maintainer Jim <br />❑ Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />IAI\/f%1^C <br />Pumping Fee.Name: <br />�- J 0 2 Shu <br />(,> �i ��wAs_lt�-eft <br />Maintenance Holes Securely Replaced: <br />11101E <br />i r t J <br />❑ Yes i;21 <br />Long Pull Fee: <br />ound <br />❑ Rise eaking <br />Address: <br />/ <br />❑ Elevated drainfield <br />❑ fles <br />Other Repairs: <br />❑ Baffles <br />13Pressure bed <br />City/State/Zip: <br />(7 ron-S <br />❑ Electrical issues <br />❑ Trenches <br />Total Cost of Servi <br />_ <br />❑ Ponding/Surfacing <br />Payment Method: <br />❑ Check ❑ Cash <br />❑ Credit <br />❑ Other: <br />7,�a <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />r\0 wf of 5?1C0ej <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 operating depth <br />designed operating <br />depth <br />structurally <br />unsound <br />eptic/holding Tank #1f_. <br />ElYes <br />No <br />Gallons: - <br />ElYes <br />ElNo <br />ElYes <br />o <br />Septic/holding Tank #2 <br />Gallons: <br />❑ Yes <br />--/ <br />�o <br />❑ Yes <br />IQ --f ' <br />❑ Yes <br />C2 No <br />❑ Pretreatment Tank <br />Gallons •' <br />❑Yes <br />❑ No <br />❑Yes <br />11No <br />El Yes <br />❑ No <br />ump Tank <br />❑ Yes <br />Gallons: <br />l: No <br />❑ Yes <br />C:,- <br />El Yes <br />No <br />How Accessedi,ff Maintenance Hole <br />Scum/Sludge Measured _. <br />Maintenance Holes Securely Replaced: <br />Reason Fo Pumping: <br />❑ Other (see attached) <br />❑ Yes i;21 <br />0-< ❑ No <br />ound <br />i <br />Did you identify a y operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />acked tanks, missing baffles, broken Cp.vefs, etc.? If so, explain in comments below. <br />Tank #1 ❑ Yes ' No <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yeso <br />System <br />❑ Structural jntegrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <br />❑ Rise eaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ fles <br />❑ Baffles <br />❑ Baffles <br />13Pressure 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 />Vv S% <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />r\0 wf of 5?1C0ej <br />L) vow. bnS Zvi f L 16. <br />Disposal: ❑ Land Application: I�lastewater Treatment Plant j'A-rN fo <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />