Laserfiche WebLink
D�VANE <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />1'1ATL' It_ ) t" - 7_ <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />Nick <br />= Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumnino Fee: d , , , , _ <br />Name: <br />Address: <br />t'( -j C) <br />►;-w wt >r v . <br />City/State/Zip: <br />Payment Method: eck ❑ Ca <br />Credit <br />Maintenance hol <br />over is damaged, <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks a ve the <br />th <br />cracked, u ured, or appears to be <br />designed operating depth <br />designed operatin <br />structural) <br />unsound <br />❑'Septic/holding Tank #1 <br />❑ Yes <br />No <br />❑ Yes D-tgo <br />❑ Yes <br />D-<O <br />Gallons:'7,5--^ <br />09'eptic/holding Tank #2 <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />Gallons: <br />Pretreatment Tank <br />❑ Yes <br />ET -No❑ <br />Yes Jo <br />ElYes <br />Gallons: -f,� <br />Gump Tank <br />❑ Yes <br />Q No <br />❑ Yes <br />El No <br />El Yes B No <br />Gallons: � <br />-low Accessed: Maintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other El (see attached) [1 No C Yes ❑ No I v,VLC '- <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tan�kss in this system, i.e., <br />­11-., Apia-_ ;—t—, -. is aFr 7 rf Cn_-Ynlgin in rnmment�elow. <br />Tank #1 ❑ Yes n No <br />Tank #2 ❑ Yes n No <br />Pump Tank ❑ Yes No <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 />10 Baffles <br />❑ Pressure bed <br />❑ Non -domestic waste <br />❑ Non -domestic waste <br />❑ Electrical issues <br />❑ Non -domestic waste <br />❑ Trenches <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑rYes ❑ No <br />Comments: �o 1 w.�e <br />r„ <br />Disoosal: ❑ Land Application: QWastewater Treatment Plant a ­ --- <br />disposal Site: <br />Lime: <br />Gallons a Z 5',? <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />rime: <br />Temperature: <br />pH: <br />> 12 ❑ <br />�""6 '�.-•.t <br />�..•�- �.�-s� -�---� ,,.�-'�-•. �`'� sue. <br />