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DVANE*� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE S'IV• ZZ <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Q Jim <br />[] Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />IF, Ilk r11/\P9 <br />Pumping Fee: <br />Scum/Sludge Measured <br />Name: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes <br />T 3-20. "'o <br />01 <br />-Yc Ilk4v-- <br />❑ Risers leaking <br />❑ Risers leaking <br />Long Pull Fee: <br />❑ Baffles <br />Addrgss: <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />Zo ..� <br />❑ Electrical issues <br />L <br />,K <br />, <br />❑ Non-domestic waste <br />Other Repairs: <br />City/State/Zip: <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />0- r,D'-d <br />Comments: <br />Total Cost of Service: <br />7 ��k <br />1 "� <br />Payment Method: <br />❑ Check ❑ Cash <br />EJ Credit <br />� <br />, o�. <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 <br />depth <br />structural) <br />unsound <br />0-9-b'pfic/hoiding Tank #1 <br />Gallons: f �y.p <br />El a—M5, <br />❑ Yes <br />❑tidir <br />❑ Yes <br />PriTo- <br />Septic/holding Tank #2 <br />Gallons: t5-0_'> <br />El 0--N o <br />❑ Yes <br />Cf No <br />❑ Yes <br />E) Pretreatment Tank <br />Gallons: <br />ElYes ElNo <br />❑ Yes <br />71No <br />❑ Yes <br />❑ No <br />Ed"Pump Tank <br />C] Yes Ca�No <br />❑ Yes <br />Gallons: <br />�2' o <br />ID Yes <br />�,� <br />How Accessed aintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />❑ Other (see attached) <br />❑ Yes <br />❑ No <br />ET Mound <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />cracked tanks. missinv baffles. broken covers. etc. 7Ifso. exnlaln In cnmmP.ntc nalnw. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes Oro <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural Integrity <br />ET Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfleld <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: ©<astewater Treatment Plant <br />Disposal Site: Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />>12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />'-�•-•� - ,��� ��►�� � • ✓., Qom' �.-.z C�r'� �`�� i� •^-'l: <br />.✓'-� �`'� .sem. ,..�-� �`'� s�.- <br />