09-16-2021 Septic Maintenance Inspection

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Septic Service, LLC 1205 LaBeaux Ave NE St. Michael, MN 55376 nATE Maintenance Inspection Form MPCA Lic. # 654 Maintainer D Jim D Duane Nick • Phone: 763-497-2764 • Email: duaneseptic@centurylink.net 1 AI\/f11rC Pumping Fee:.: Scum/Sludge Measured Name: Reason For Pumping: ❑ Other (see attached) ❑ Yes 0 No 0"Yes ❑ No ❑ Mound ❑ Risers leaking ❑ Risers leaking Long Pull Fee: ❑ Elevated drainfield Address: ❑ Baffles ❑ Baffles ❑ Pressure bed ❑ Non-domestic waste ❑ Non-domestic waste ❑ Electrical issues Other Repairs: City/State/Zip: ❑ Non-domestic waste ❑ Ponding/Surfacing ❑ Effluent Filter/screen ❑ Other: Total Cost of Service: ; �`!. Payment Method: ❑ Check ❑ Cash ❑ Credit Tank leaks below the Tank leaks above the Maintenance hole cover is damaged, Tank (check if present) designed operating depth designed operating depth cracked, unsecured, or appears to be structural) unsound Septic/holding Tank #1 Gallons: „ ❑ Yes In No ElYes O No ❑ Yes 0 -'No ❑-Septic/holding Tank #2 -No Gallons: '.. :' :" I]Yes Q ❑ Yes ❑- No ElYes ElNo ❑ Pretreatment Tank Gallons: ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑"Pump Tank Gallons: ., ❑ Yes D No El Yes 0' No E] Yes ❑,- No — How Accessed: ❑ Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: ❑ Other (see attached) ❑ Yes 0 No 0"Yes ❑ No ❑ Mound Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., cracked tanks, missing baffles, broken covers, etc.? Ifso, explain in comments below. Tank #1 ❑ Yes ❑ No Tank #2 ❑ Yes ❑ No Pump Tank ❑ Yes ❑ No System ❑ Structural integrity ❑ Structural integrity ❑ Structural integrity ❑ Mound ❑ 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: ER'[and Application: ❑ Wastewater Treatment Plant Disposal Site: 3/1 1 Lime: ✓ Gallons Z Y- -o Plowed: ❑ Yes -0-No Time: 3 S_ j Temperature: 4,15— pH: t 2,j > 12 E3' Time: L/ 2 7 Temperature: G pH: 12-3 > 12 Er— '�.�.t �r � �;,��+1,/ '� � 4�.,,r . � %'� �•�.t fir � �'; ��/ •� ,✓�-'�-� �� .sem. -�•--' ,f-'�-� S�� sem.