Laserfiche WebLink
DVANE*� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE l -2 Z *,Z Z <br />Maintenance Inspection Form <br />MPCA Lic. # 654 <br />Maintainer Jim <br />D Duane <br />Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.not <br />I AI\/f1lf%1= <br />Pumping Fee:.7 <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced:Reason <br />Name: r� <br />J� r <br />Long Pull Fee: � 9D <br />es El No <br />❑ Risers leaking <br />Address: 5 L)p -5- <br />ou Crv't-ij 9' i <br />Other Repairs: _ <br />❑ Pressure bed <br />City/State/Zip: <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Total Cost of Servic <br />Cleaned? ❑ Yes ❑ No <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />�./ <br />y� <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 depth <br />structural) unsound <br />Septic/holdln� Tank #1 <br />Gallons: <br />1:1 Yes <br />No <br />El Yes No <br />❑ Yes C-, o <br />Septic/holding Tank #2 <br />Gallons: 1 S—ziG <br />❑Yes <br />0- No <br />❑ Yes E No <br />❑ Yes No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />el -Pump Tank ` <br />El Yes <br />No <br />❑Yes �f <br />_No � <br />El Yes l�No <br />Gallons: �� U <br />How Accessed: aMaintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced:Reason <br />For P mping: <br />C <br />El Other (see attached) <br />El Yes CVNo <br />es El No <br />❑ Risers leaking <br />c./ <br />Did you identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, i.e., <br />,eracked tanks, missing baffles, broken Vis, etc.? !f so, explain In comments�w. <br />Tank #1 ❑ Yes FerNo Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes No <br />System <br />❑ Structural Integrity ❑ Structural integrity <br />❑ Structural Integrity <br />ound <br />p Risers leaking ❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfieid <br />❑ Baffles ❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste ❑ 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: •-Q Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: <br />Gallons 30 o C <br />Plowed: ❑ Yes <br />-D -No <br />Time: I ., c <br />Temperature: lv 1 <br />pH: 2 . <br />> 12--0-, <br />Time: t., W <br />Temperature: 6 � <br />pH: 2--6 <br />> 12 <br />i_ <br />