Laserfiche WebLink
DVANE�� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE L : Y- ZS <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Dv " Maintainer 0 Jim <br />J�XNick <br />0 Sam <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />iNvnir_F <br />Pumping Fee: <br />Name: <br />Y <br />.. <br />�al�,� � l �`S ye <br />Long Pull Fee: <br />Address: <br />g �_� l-�kk-�- ��►� Rol <br />Other Repairs: <br />City/State/Zip: <br />C) <br />Total Cost of Se <br />k <br />Payment Method: Check ❑ Cash ❑ Credit <br />o� <br />Tank check if resent <br />( present) <br />�deslgned <br />the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />cracked, unsecured, or appears to be <br />0low <br />operating depth <br />designed operating depth <br />structurally unsound <br />eptic/holding Tank #1 <br />Gallons: k 2,5-c <br />❑ Yes <br />s ❑ No <br />❑ Yes E?NU <br />❑ Yes PrI o <br />11/4!re: holding Tank #2 <br />ElGallonsns: Yes <br />❑ No <br />� Z� <br />ElYes 2 No <br />❑ Yes �-_S No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />El Yes ❑ No <br />El Yes El No <br />q�ump Tank <br />El Yes <br />�No <br />El Yes L3 No <br />❑ <br />Gallons: L <br />Yes ,C;?No <br />How Accessed: En Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />CT'Ye/�s El No <br />1 T1 es ❑ No <br />�VVL".1'4 <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />,cracked tanks, missing baffles, broken_,covers, etc.? If so, explain in commenq below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes ETNo <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 />❑ 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: ET Wastewater Treatment Plant <br />Disposal Site: <br />Lime: <br />Gallons Z(.o.o <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />��''''�-� �`'✓" sue- ...1--",. ��'�-�- �S✓" sue. <br />