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Maintenance Inspection Form <br />DUANE*� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE (0 - Z c' _-125 <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />rsIck <br />am <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name: <br />j <br />Address: 1, <br />Long Pull Fee: <br />Other Repairs: <br />City/State/Zip: <br />Total Cost of Se <br />l Gt,�f%� <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />J-1 <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />below the <br />Tank (check__ <br />— <br />--�ezrgnaa-uperating depth <br />designed operating depth <br />structurally unsound <br />❑,. eptic/holding Tank #1 <br />❑ Yes ❑ lo_ <br />El Yes O oN <br />❑ Yes ❑-9 <br />Gallons: ,�Qo <br />eptic/holding Tank #2 <br />❑ Yes C9' No <br />❑ Yes 2--No <br />❑ Yes ❑ No <br />Gallons: I sL" <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />E Pump Tank <br />�lo <br />❑ Yes ef" No <br />❑ Yes ff No <br />Gallons: i,p ego <br />❑ Yes <br />How Accessed: Maintenance Hole <br />El Other (see attached) <br />Scum/Sludge Measured <br />f1'Yes ❑ No <br />Maintenance Holes Securely Replaced: <br />es ❑ No <br />Reason For Pumping: <br />�- L ✓Ly <br />Did you Identlfy any operational issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />hacked tanks, missing baffles, broken covers, etc.? If so, explain In comments below. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes ZI 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: Ei<a—nd Application: ❑ Wastewater Treatment Plant <br />Disposal Site: <br />Time: <br />V Lime: <br />7,0"-1 <br />Gallons j <br />Temperature: <br />Plowed: <br />pH: <br />❑ Yes <br />DINO <br />> 12 Br' <br />Time: <br />z 17Temperature: <br />j'1- `I <br />pH: <br />> 12 113 <br />