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DV�NE� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE ' 1-1 t-1- -Z 0-� <br />Maintenance Inspection Form <br />MPCA Lic. #L4286 <br />Maintainer 0 Jim <br />.lick <br />0 Sam <br />® Phone: 763-497-2764 <br />® Email: duaneseptic@centurylink.net <br />irvvnirF <br />Pumping Fee: <br />Name: <br />Long Pull Fee: <br />Address: <br />-7 <br />o <br />6r <br />Other Repairs: <br />City/State Zip: <br />C) cc '-0 <br />Total Cost of S <br />�� <br />Payment Method: Check ❑ Cash <br />❑ Credit <br />O� <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />s below the <br />Tank (chec_ <br />_._ — - --- <br />- berating depth <br />designed operating depth <br />cracked, unsecured, <br />or appears to be <br />structural) <br />unsound <br />Septic/holding Tank #1 <br />Gallons: ( Z� <br />^ -/ <br />El Yes �o <br />❑ Yes B o <br />❑ Yes <br />2-90 <br />Septic/holding Tank #2 <br />Gallons: (Zsv <br />❑ Yes No <br />❑ Yes Fwol-10 <br />❑ Yes <br />❑-150-- <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ElNo <br />❑ Yes ElNo <br />ElYes <br />ElNo <br />2"Pump Tank <br />❑ Yes Etl No <br />❑ Yes <br />Gallons: Z <br />tel No <br />❑ Yes <br />81 No <br />How Accessed:. Maintenance Hole <br />Scum/Sludge Measured <br />Maintenanncce Holes Securely Replaced: <br />Reason For Pumping: <br />El Other (see attached) <br />®'Yes El <br />9-Yes ❑ No <br />M--12 ` <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e., <br />wracked tanks, missing baffles, broken coffers, etc.? If so, explain in comments_below. <br />Tank #1 ❑ Yes VINo <br />Tank #2 ❑ Yes ❑ o <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <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: ❑ Wastewater Treatment Plant <br />Disposal Site: 1 <br />Lime: <br />Gallons Z$ <br />Plowed: <br />❑Yes <br />ET -No <br />Time: o � .3 <br />Temperature: <br />pH: <br />12, 3 <br />> 12 rT- <br />Time: k 1>1 <br />Temperature: i <br />pH: <br />1 1- Z <br />> 12 E1 <br />