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DV�E� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />n nr= '?_ , I — Z J� <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer Jim <br />Nick <br />fti Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping FeE <br />Name: <br />Address:,Z —4-)48e� <br />Long Pull Fe, <br />Other Repair <br />City/State/Zip: <br />Payment Method: ElCheck ElCash <br />ElCredit <br />Total Cost of "�4,, V <br />ok <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 />Septic/holding Tank #1 <br />'�b <br />El Yes C.I-No <br />El Yes No <br />El Yes <br />4❑ No <br />Gallons: 1 5v <br />ET'S'eptic/holding Tank #2 <br />040 <br />❑ Yes <br />N❑ o <br />Gallons: <br />❑ Yes Cf No <br />❑ Yes <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />Eff1pump Tank <br />❑ Yes No <br />El Yes No <br />El Yes <br />Gallons: t 500 <br />How Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) 2'Yes El No El Yes ❑ No iL'_ �_� <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />..�...a — i. ...;. ; ., F—m— h. L. n .- 1— otr 7 rf cneynlaln in rnmmpnt--flelow. <br />Tank #1 ❑ Yes RT No <br />Tank #2 ❑ Yes No <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: ❑ Land Application: EMastewater Treatment Plant, � <br />Disposal Site: Lime: Gallons Plowed: ❑ Yes ❑ No <br />Time: Temperature: pH: > 12 ❑ <br />Time: Temperature: pH: > 12 ❑ <br />��--�-�- �`'� sue. ,✓�-'� �`'" .s�- <br />