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Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 9 -11- Z4 <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer ❑ Jim <br />*N ick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic9centurylink.net <br />Pumping Fee: <br />Name: <br />IIY V VIIiG <br />Long Pull Fee: <br />Address: <br />7 <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Servi <br />i �av` <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 />designed operating <br />depth <br />, <br />structural) <br />unsound <br />��� <br />i�'Septic/holding Tank #1 <br />Gallons• s,�o <br />El Yes �f No <br />❑ Yes <br />,L�'No <br />❑Yes <br />No <br />271 eptic/holding Tank #2 <br />❑ Yes No <br />❑ Yes <br />-11 <br />Gallons: 90-0 <br />No <br />❑ Yes <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />/Pump Tank <br />Gallons: 6,4;Eo �,JJ <br />❑ Yes No <br />❑ Yes <br />Jeil_No <br />❑ Yes <br />How Accessed: aintenance Hole Scum/Stud e Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ es ❑ No El-les ❑ No "AC" <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />c acked tanks. missing haffTps_ hrnkpn rn�m Ptr 7 TFcn Pvnlain in rnrnrr tP ha/.,u <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes Yfro <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <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: �d Application: ❑ Wastewater Treatment Plant <br />Disposal Site: V <br />Gallons'Z 1cQ-3 <br />Plowed: ❑ Yes <br />❑-K-0 <br />Time: 5� "� <br />Temperature: <br />ZD,I <br />pH: 2. Z <br />> 12 <br />Time: t Z Z -7 <br />Temperature: <br />,,P' -?" <br />pH: l L. I <br />> 12 <br />UK• <br />