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DUANE� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE S_ /1,2Z - <br />Maintenance <br />f -2Z - <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />D Duane <br />A, Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: 3 3 b <br />Na : <br />Pump Tank ❑ Yes o <br />System <br />nvvvtVt <br />` c� <br />❑ Structural integrity <br />t_f� , <br />z <br />❑ Risers leaking <br />❑ Risers leaking <br />Long Pull Fee: <br />❑ Baffles <br />Address: <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />(.0 <br />❑ Electrical issues <br />2 S&O <br />Other Repairs: <br />❑ Ponding/Surfacing <br />City/State/Zip: <br />❑ Effluent Filter/screen <br />❑ Other: <br />(.qV0V\_0 <br />Comments: <br />Total Cost of Service: <br />k <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 />designed operating depth <br />designed operating <br />depth <br />cracked, unsecured, or appears to be <br />unsound <br />0-8�structural) <br />c/holding Tank #1 <br />Gallons: tZ51171 <br />❑ Yes 0'1lo <br />❑ Yes <br />0TVo <br />❑ Yes <br />p'No <br />❑ Septic/holding Tank #2 <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />ump Tank <br />C1 Yes No <br />❑ Yes <br />Gallons:'aQo <br />o <br />❑ Yes <br />❑ No <br />How Accessed: aintenance Hole Scum/Sludge Measured r!:�����son For Pumping:❑Other (see attached) ❑Yes �t ; h . <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In thls system, Le., <br />cracked tanks. migcInn haffla h_Lea .a erg 7 ra, ,-,.. , <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes O No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />EMound <br />O Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfleld <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: O Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: <br />Gallons Z 2,W <br />Plowed: ❑ Yes <br />❑ No <br />rime: 7 <br />Temperature: <br />time: / a j' <br />Temperature: 5"4, <br />pH: ( 2— S- <br />> 12 91 <br />