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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 24 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />Nick <br />Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />v8�- <br />Name: <br />,�,>�.�1 s I�x �•d� <br />Long Pull Fee: <br />Address: <br />Other Repair <br />City/State/Zip: <br />Q r-0 A 0 <br />2Z,s0 r 3 <br />8 IS <br />Total Cost of ervice: <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />53 l <br />YOU - <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />crackedunsecured, or appears to be <br />designed operating depth <br />designed operating depth <br />, <br />structural) <br />unsound <br />�ptic/holding Tank #1 <br />❑ Yes <br />n No <br />ElYes <br />Gallons: <br />ElYes <br />No <br />❑ Septic/holding Tank #2 <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />ElYes ElNo <br />ElYes <br />❑ No <br />El"Pump Tank <br />Gallons: j j�� <br />El Yes <br />No <br />El Yes No <br />El Yes <br />f�No <br />How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) es El No el Yes ❑ No S e <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.? Ifso. exolain in comments- low. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes ❑ No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ETMound <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: K-Wastewater Treatment Plant VtkW-' +'k- - <br />Disposal Site: <br />Lime: <br />Gallons f3 6-0 <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />a rt <br />