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DUANE*� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE / D -,9/ q- 2L._ <br />Maintenance Inspection Form <br />M P " C. # 654 <br />Maintainer Jim <br />Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: 1,31 <br />� � <br />Tank #2 Cl Yes o <br />Name: <br />INVUlUh <br />"lut <br />Long Pull Fee: /0 <br />❑ Structural integrity <br />Address: <br />1 � 6 <br />ound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />� <br />Other Repairs: g du <br />fes () <br />City/State/Zip: <br />❑ Pressure bed <br />❑ Trenches <br />� <br />ttle <br />kovi,c <br />❑ Ponding/Surfacing <br />Total Cost of Servic <br />IV56 <br />❑ Effluent Filter/screen <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Comments: <br />Maintenance hole cover is damaged, <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />structurally unsound <br />Septic/holdin Tank #1 <br />Gallons: / <br />❑ Yes `❑ No <br />❑ Yes Iff-golo­ <br />❑ Yes .2-10 <br />eptic/holding Tank #2 <br />Gallons:- 2. �'Z3 <br />❑ Yes Q-Pda— <br />❑ Yes CyPdtf <br />❑ Yes o <br />Ca'IV <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />ump Tank <br />Gallons: /g.p <br />i <br />I -]Yes No <br />❑ Yes <br />❑ Yes -e'No <br />How Accessed:e"Maintenance Hole Scum/Sludge Measured Maintenance <br />Holes Securely Replaced: Reason For P ping: <br />El Other (see attached) ❑Yes a�Yes ❑ No <br />Y-- wcnui y an operanonai issues or unsare conditions while assessing the sewage tanks In this system, i.e., <br />Pfl Ninllc. mi -1— h.ffi a h—&— .a <br />Tank #1 ❑ Yes o <br />Tank #2 Cl Yes o <br />_-....... ... - ............... .. <br />Pump Tank ❑ Yes o <br />... <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural Integrity <br />ound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfleld <br />11 Baffles <br />❑ Non-domestic waste <br />❑ Baffles <br />❑ Non-domestic waste <br />❑ Baffles <br />❑ Electrical Issues <br />❑ Pressure bed <br />❑ Trenches <br />❑ Non-domestic waste <br />❑ Ponding/Surfacing <br />❑ Effluent Filter/screen <br />❑ Other: <br />Cleaned? ElYes ❑ No <br />Comments: <br />uisposal: u Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: _ Lime: Gallons Plowed: ❑ Yes ❑ No <br />Time: Temperature: pH: >12 ❑ <br />Time: Temperature: pH: >12 0 <br />