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DVANE� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE '� - 2'0 i. G1 <br />Maintenance <br />Maintainer <br />• Phone: 763-497-2764 <br />Inspection Form <br />MPC :Lic. #L4286 <br />Jim <br />❑ Nick <br />• Email: duaneseptic@centurylink.net <br />I10Lyle] W <br />Pumping Fee: 3 s- <br />p�.��� <br />1 �t3L� <br />(�-a t �u�� <br />Name: <br />Ti1a''t-1 <br />Long Pull Fee: <br />Address: t)I A <br />Cr <br />Other Repairs: <br />City/State/Zip: <br />O <br />Total Cost of Service: _ <br />Payment Method: ZrCheck ❑ Cash <br />❑ Credit <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />Tank (check if present) <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally <br />unsound <br />Septic/holding Tank #1 <br />n <br />�- <br />Gallons: /W <br />ElYes <br />No <br />ElYes � No <br />❑ Yes <br />❑ No <br />❑ Septic/holding Tank 42 <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />f,. <br />Pump Tank <br />ZN <br />ZN <br />Gallons: -;- LV <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />,el No <br />I <br />How Accessed:Z Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />El Yes RJ No <br />-rinaYes ❑ No <br />./ <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />_,,2�5'cked tanks, missing baffles, broken covers, etc.? If so, explain in comments 40ew. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes ❑ No <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />1:1,F,14alted drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />K 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: Yd wastewater Treatment Plant V_,A 7�"t o 1;. <br />Disposal Site: <br />Lime: <br />Gallons <br />Plowed: ❑ Yes ❑ No <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />Time: <br />Temperature: <br />pH: > 12 ❑ <br />