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DV�NE�� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE ( T L (e - Z S <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer = Jim <br />Nick <br />7=Yl Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: l , _ _ <br />Name: <br />uv r vws_ <br />Long Pull Fee: <br />Other Repairs: <br />r <br />L:� <br />t <br />Address: t PL <br />I�V- <br />City/State/Zip: <br />Total Cost of S <br />Payment Method: <br />❑ Check ❑ Cash ❑ Credit <br />Tank (check if presen <br />Tank leaks below the <br />designed operating depth <br />Tank leaks above the <br />designed operating depth <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />structural) unsound <br />Septic/holding Tank #1 <br />Gallons: tS� <br />❑ Yes ❑� <br />El Yes Yes <br />lf" <br />❑ Yes ._ <br />Septic/holding Tank #2 <br />Gallons: 1 -&!r <br />❑ Yes No <br />❑ Yes <br />ElYes 4] N <br />❑ Pretreatment Tank <br />Gallons: <br />El Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />Pump Tank <br />Gallons: 2117 <br />❑ Yes ;�N o <br />❑ Yes <br />No <br />❑ Yes .0 No <br />How Accessed: Maintenance Hole <br />Scum/S/ludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />Z es ❑ No <br />es ❑ No <br />a� <br />Did you Identify 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 13Ao <br />Tank #2 ❑ Yes 17 No <br />Pump Tank ❑ Yes 21N o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />PT 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: ❑ Land Application: 13" astewater Treatment Plant t. A. G' 0 <br />Disposal Site: <br />Lime: <br />Gallons Z42o® <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />