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Maintenance Inspection Form <br />DVANE* <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 8-- 25" = 23 <br />MPCA L4286 <br />Maintainer Jim <br />0 Duane <br /><$FNick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />lhfvnlr l= <br />Pumping Fee: <br />Name: <br />Long Pull Fee: <br />Address: <br />t/ i _ <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Servic • <br />Payment Method: ❑ Check ❑ Cash ❑ 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 <br />depth <br />designed operating depth <br />structurally unsound <br />tic/holding Tank #1 <br />Gallons: Cc,>t> 0 <br />❑ Yes <br />❑ Yes 9'170— <br />❑ Yes Rr Vo <br />EY'Septic/holding Tank #2 <br />❑ Yes <br />Ge <br />❑ Yes �o <br />❑ Yes <br />Gallons: CQ <br />o <br />2__l o <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ umpTank <br />Gallons: f V ,,,> <br />❑ Yes <br />j <br />❑ Yes -E No <br />❑ Yes e"No <br />How Accessed: Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />ElOther (see attached) <br />❑ Yes 11_*�No <br />GT//Yes ❑ No <br />. (n <br />Did you Identlry any operational Issues or unsafe condltlons while assessing the sewage tanks In this system, l.e,, <br />racked tanks, missing baffles, broken c vers, etc.? Ifso, explain In comments ow. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes o <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: ETILand Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Y <br />Lime: "� <br />Gallons Z, / <br />Plowed: <br />❑ Yes <br />ET No <br />Time: <br />/ <br />Temperature: 9, <br />pH: <br />2- i <br />> 12 <br />Time: <br />Temperature: I 5.V <br />pH: <br />2.•Z <br />>12 45 <br />