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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 t© <br />MPCA Lic. #L4286 <br />Maintainer EJ Jim <br />SXNick <br />E::] Sam <br />e Phone: 763-497-2764 <br />o Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: <br />Name.• <br />Long Pull Fee: <br />Address: <br />City/State/Zip: <br />Other Repairs: <br />(!) <br />Total Cost of Ser <br />'L,�avt _k <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank leaks above <br />the <br />Maintenance hole cover is damaged, <br />)elow the <br />Tank (check it praa�ncj—- <br />- - des gne <br />operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structural) unsound <br />O'S"e'ptic/holding Tank #1 <br />Gallons: t L � <br />El Yes <br />0—(tr6 <br />❑Yes <br />-B-�o <br />❑Yes 0"N <br />ET'Septic/holding Tank #2 <br />❑Yes <br />Ft No <br />❑ Yes <br />i�r No <br />�'o <br />❑ Yes C7 No <br />Gallons: t '2,5-v <br />❑ Pretreatment Tank <br />❑ Yes <br />❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />Gallons: <br />B'Pump Tank <br />❑ Yes E No <br />Gallons: 1 'L5­0 <br />❑ Yes <br />0 No <br />❑ Yes <br />t- No <br />How Accessed:121kintenance Hole <br />Scum/Sludge Measured <br />Maintena-nce Holes Securely Replaced: <br />Reason For Pumping: <br />❑Other (see attached) <br />tJ YeS ❑ No <br />Yes ❑ No <br />Did you Identify any operational issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />racked tanks, missing baffles, broken covers, etc.? Ifso, explain in comment below. <br />Tank #1 ❑ Yes E7rNo <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes E3No <br />System <br />❑ Structural Integrity <br />❑ Structural integrity <br />❑ Structural Integrity <br />©`Mound <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: ❑ tq d-Application: ❑ Wastewater Treatment Plant <br />Disposal Site: t J L <br />Lime: <br />Gallons 2- 3�J <br />Plowed: ❑ Yes <br />Time: j( <br />o �( <br />Temperature: t'Z. 9 <br />pH: f Z- C <br />> 12 <br />Time: <br />tf <br />Temperature: I '2 - -� <br />pH: 2, - V <br />> 12 <br />