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DVE* <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael,MN 55376 <br />,7 <br />DATE -Zq'Z,1i <br />Maintenance Inspection Form <br />ZMJM <br />CA Lic. # 654 <br />Maintainer <br />Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />intvnir_F <br />Pumping Fee: <br />Scum/Sludge Measured <br />Name: <br />Reason For Pumping: <br />❑ Other (see attached) <br />D Yes 0.6. <br />q ❑ No <br />❑ Risers leaking C3 'Risers leaking <br />❑ Elevated dralnfield <br />❑ Baffles <br />Long Pull Fee: <br />❑ Pressure bed <br />Address: 7:7a <br />2-( <br />❑ Trenches <br />> 12--B <br />❑ (Non-domestic waste <br />❑ Ponding/Surfacing <br />V4-,( VLA <br />C3 Effluent Filter/screen <br />Other Repairs: <br />City/State/Zip: <br />Comments: <br />C) �D f1t 7J <br />Total Cost of Service: <br />�; <br />poo <br />Payment Method: 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 />cracked, unsecured, or appears to be <br />designed operating depth <br />designed operating depth <br />structural) <br />unsound <br />Sholding Tank #1 <br />Gallons: %Lj'& <br />G����ons: <br />❑ Yes �o <br />^ <br />❑ Yes >:7 -No <br />❑ Yes <br />-C�1 No <br />❑`'Septic/hgldi% Tank #2 <br />❑ Yes 11 <br />El Yes � <br />El Yes <br />❑ No <br />Gallons: [�ij <br />0 <br />❑ Pretreatment Tank <br />Gallons: <br />E] Yes El No <br />❑ Yes CD No <br />El Yes <br />❑ No <br />EI Pump Tank <br />EIYes o <br />❑ Yes <br />Yes <br />Gallons: 1'2ijD <br />P"N <br />P_<❑ <br />PIA <br />How Accessed: aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />D Yes 0.6. <br />q ❑ No <br />❑ Risers leaking C3 'Risers leaking <br />Dld you idenfy a y operational Issues or unsafe condit' s while assessing the sewage tanks in this system, I.e., <br />ti <br />z acked tanks, missing baffles, broke overs, etc.? If so, explain In commen�elow. <br />Tank #1 D Yes A,No <br />Tank #2 ❑ Yes 0 No Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural Integrity ❑!Structural integrity <br />Mound <br />❑ Risers leaking <br />❑ Risers leaking C3 'Risers leaking <br />❑ Elevated dralnfield <br />❑ Baffles <br />❑ Baffles ❑ (Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste ❑ Electrical Issues <br />❑ Trenches <br />> 12--B <br />❑ (Non-domestic waste <br />❑ Ponding/Surfacing <br />C3 Effluent Filter/screen <br />❑ Other: <br />Craned? ❑ Yes ❑ No <br />Comments: <br />Disposal: --❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: Gallons <br />oft 0 <br />Plowed: El Yes <br />-8-96 <br />Time: F <I <br />Temperature: <br />pH: <br />> 1.2--CJ- <br />Time: 5t <br />Temperature: <br />,4 <br />pH: <br />> 12--B <br />