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NOR <br />DUANE� <br />Septic Service, LLC <br />1205 LaSeaux Ave NE <br />St. Michael, MN 55376 <br />DATE 0_30-7-( <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer C�l Jim <br />C�] Duane <br />*Dick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />INVOICE <br />Pumping Fee: 3� <br />Tank #2 ❑ Yes ONo <br />Na e: <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />Long Pull Fee: <br />❑ Mound <br />Address: <br />Cr + � <br />A <br />❑ Elevated drainfleld <br />❑ Baffles <br />1531156ffles <br />15-70 <br />❑ �PPcs sure bed <br />vt <br />,. <br />Other Repairs:t� � <br />� j$ � n t -4, <br />� <br />City/State/Zip: <br />(j4t% p.4 6,1+ <br />171 Non-domestic waste <br />❑ Ponding/Surfacing <br />Total Cost of Service: <br />❑ Effluent Filtertscreen <br />Payment Method: <br />❑ Check ❑ Cash <br />❑ Credit <br />Cleaned? ❑ Yes ❑ No <br />Comments: � eelN­0Cov¢ r f �� �l i ) 4 ti.4 k • W <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) unsound <br />t llonsc/hol Tank #1 <br />E] Yes � <br />❑ Yes <br />t� <br />Gallons: app <br />p4 <br />es <br />epticlholding Tank #2 <br />Gallons: 1 <br />ED Yes L <br />❑ Yes <br />� <br />El <br />_L_1�0 <br />El Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />ElYes <br />ElNo <br />EIYes <br />17No <br />❑ Pump Tank <br />Gallons; <br />O Yes C1No <br />C3 Yes <br />F-1No <br />LJ Yes <br />CDNo <br />How Accessed: aintenance Hole Scum/Sludge Measured Maintenance Holes Securely Replaced: Reason For Pumping: <br />❑ Other (see attached) ❑ Yes Fr -No DI?e­s ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage ranks in this system, i.e., <br />cracked tanks, missing baffles, broken Fevers, etc.? It so, explain in comments below. <br />Tank #1 ❑ Yes o <br />Tank #2 ❑ Yes ONo <br />Pump Tank ❑ Yes ❑ No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Mound <br />❑ Risers leaking <br />❑ R'Pers leaking <br />❑ Risers leaking <br />❑ Elevated drainfleld <br />❑ Baffles <br />1531156ffles <br />❑ Baffles <br />❑ �PPcs sure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues <br />C trenches <br />(j4t% p.4 6,1+ <br />171 Non-domestic waste <br />❑ Ponding/Surfacing <br />tuP <br />❑ Effluent Filtertscreen <br />❑ Other: <br />$k�<< <br />Cleaned? ❑ Yes ❑ No <br />Comments: � eelN­0Cov¢ r f �� �l i ) 4 ti.4 k • W <br />v <br />Disposal: ❑Land Application: ❑Wastewater Treatment Plant I <br />Disposal Site: <br />Lime: Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />>12 ❑ <br />Time: <br />Temperature: <br />pH: <br />> 12 ❑ <br />We') 11neg <br />