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Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 DATE 9 - 1 ce' 21/ Maintenance Inspection Form MPCA Lic. #L4286 Maintainer Jim ick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net Pumping Fee: L13 �. � Name: IIV V VII.0 Long Pull Fee: Address: Other Repairs: City/State/Zip: V-0 "_0 Total Cost of Servic �rwk Payment Method: ❑ Check ❑ Cash ❑ Credit Tank (check if pr Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, designed operating depth designed operating depth , crackedunsecured, or appears to be structural) unsound Septic/holding Tank #1 Gallo s: Is*-.90 ❑ Yes El. -I �o ❑ Yes El -No ❑ Yes C Septic/holding Tank #2 Gallons: Ca ❑ Yes No ❑ Yes ®'No ❑ Yes ❑ No ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Pump Tank Gallons: L.&_o 0 ❑ Yes No ❑ Yes No ❑ Yes l�No How Accessed. Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) O'Yes ❑ No I❑ Yes ❑ No ice, Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., cracked tanks. missina baff7e.s. hrnken rnvarc atr 7 rf cn avnlain in rnm fr 1- 1- Tank #1 ❑ Yes Oo Tank #2 ❑ Yes ONo Pump Tank ❑ Yes o System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ound ❑ Risers leaking ❑ Risers leaking ❑ Risers leaking ❑ Elevated drainfield ❑ Baffles ❑ Baffles ❑ Baffles ❑ Pressure bed ❑ Non -domestic waste ❑ Non -domestic waste ❑ Electrical issues ❑ Trenches ❑ Non -domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Cleaned? ❑ Yes ❑ No Comments: Disposal: ❑'r-a-nd Application: ❑ Wastewater Treatment Plant Disposal Site: U ( Lime: Gallons Z_2z> Plowed: ❑ Yes 121_1 o Time: Z i 7 Temperature: z 0, / pH: Z� z > 12 O' Time: Z z(7 Temperature: Z 0, (� pH: 2 - L > 12 :ff- :/'r' ,�+.ram,, .�_�� ►�,,., �-- ,...�- �-� ,�'� sue. ,.�-'�-� �`'� .sue•