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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE q --5— 2 7 <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: (lt2-� <br />Name: �0 I <br />; C1Ae'e l <br />Long Pull Fee: <br />Address: <br />1 <br />✓� I" L b'1 <br />Other Repairs: <br />City/State/Zip: <br />Our ®YA0 <br />Total Cost of Servic <br />;1 <br />Payment Method: <br />❑ Check ❑ Cash <br />❑ Credit <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 />h <br />designed operating <br />depth <br />, <br />structural) <br />unsound <br />El"Septic/holding Tank #1 <br />Gallons: � �� <br />El Yes <br />Eil o <br />El Yes <br />�o <br />❑ Yes <br />No <br />In" <br />Septic/holding Tank #2 <br />Gallons: ['0.9 0 <br />El <br />�� <br />❑ Yes <br />/ <br />eNo <br />❑ Yes <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />Pump Tank <br />Gallons: 10 &0 <br />❑ Yes <br />No <br />❑ Yes <br />�No <br />❑ Yes <br />C�o <br />How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />ElOther (see attached) es ElNo 9—Y-es ❑ No ivv�• ✓t <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 rctrecs. etc. 2 rf an. exnlain in rnmmantc LwTrn w <br />Tank #1 ❑ Yes FA o <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />RrMound <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: 6 Lid Application: ❑ Wastewater Treatment Plant <br />Disposal Site: IV\\ <br />Lime: <br />Gallons 3cao <br />Plowed: <br />❑ Yes <br />(?<O <br />Time: <br />Temperature: c,-7 <br />pH: <br />Z, 2-- <br />> 12 <br />Time: <br />Temperature: Zq_ 0 <br />pH: <br />t Y 2- <br />> 12 <br />� '.� fir �'� �r�/ •� � ���; '-�.-�.� Cyr • �', ��,r�/" •� • <br />�'�s�- <br />