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DV�E� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE —7-- 1 i ` " <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer U Jim <br />ick <br />® Phone: 763-497-2764 <br />® Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: <br />sn <br />Long Pull Fee: <br />Address: i <br />l i <br />l -Oki <br />Repairs: <br />City/State/Zip: <br />Total Cost of Se ce: <br />Payment Method: ElCheck El Cash <br />❑ Credit <br />j <br />i 33 <br />Tank (check if presen <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) unsound <br />Septic/holding Tank #1 <br />Yes <br />No <br />Gallons: t:D <br />❑ Yes No <br />❑ Yes No <br />❑ <br />EI-Septic/holding Tank #2 <br />El Yes No <br />❑ Yes No <br />El Yes <br />�- <br />�o <br />Gallons: t3� <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />Pump Tank <br />❑Yes No <br />❑Yes No <br />❑Yes <br />No <br />Gallons: �-J <br />How Accesseq9f Maintenance Hole <br />❑ Other (see attached) <br />Scum/Slu e Measured <br />d'Yes ❑ Nof <br />Maintenance oles Securely Replaced: <br />Yes ❑ No <br />Reason For Pumping: <br />i <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />cr ked tanks, missing baffles, broken covers, etc.? If so, explain in comments low. <br />Tank #1 ❑ Yes pllqo <br />Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes 2rNo <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Njgfind <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />OElevated 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: 21Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons 22,_ r_-0 <br />Plowed: ❑ Yes o <br />Time: 3 33--7 <br />Temperature: <br />pH: t z _-t > 12 <br />Time: L(Z 7 <br />Temperature: L `1,`C <br />pH: \ 1, -& > 12 ❑ <br />01 <br />IN <br />-`.� �'� <br />,,,�-�-�- ,�`'� sue. � ,✓�''�-� �`'- s%47 <br />