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DVANE*� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE q `2'Z' <br />Maintenance Inspection Form <br />MPGA Lic. # 654 <br />Maintainer EZJim <br />Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />tnfvnlf%P <br />Pumping Fee: <br />Scum/Sludge Measured <br />Name: <br />0l00c �'� t If1 <br />s` <br />Long Pull Fee: <br />❑ Yes UAo <br />Address: <br />' •� <br />❑ Elevated drainfield <br />❑ Baffles ❑ Baffles <br />1 <br />❑ Pressure bed <br />Other- Repairs: <br />❑ Electrical Issues <br />City/State/Zip.- <br />ity/State/Zip:0 <br />❑ Non-domestle waste <br />❑ Ponding/Surfacing <br />0 <br />❑ Effluent Filter/screen <br />❑ Other: <br />Total Cost of Serv' 2� <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <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/holding Tank #1 <br />Gallons: Z 7S7� <br />❑Yes No <br />❑Yes o <br />❑Yes C�'FJo <br />❑ Septic/holding Tank #2 <br />Gallons: <br />❑ Yes C]No <br />❑ Yes EINo <br />C]Yes ❑ No <br />❑ Pretre ment Tank <br />Gall <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Pump Tank <br />Gallons: j 1 <br />❑ Yes No - <br />❑ Yes to <br />- <br />❑ Yes •E7 No <br />How Accessed Maintenance Hole <br />Scum/Sludge Measured <br />Maintenance Holes Securely Replaced: <br />Reason For umping: <br />13Other (see attached) <br />❑ Yes UAo <br />9 -Yes ❑ No <br />' •� <br />Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system, I.e., <br />cracked tanks, missing baffles, broken covers,_ etc.? If so, exolafn in comments below. <br />Tank #1 ❑ Yes o Tank #2 ❑ Yes o <br />Pump Tank ❑ Yes o <br />System <br />❑ Structural integrity ❑ Structural Integrity <br />❑ Structural Integrity <br />Mound <br />El Risers leaking ❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles ❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste ❑ Non-domestic waste <br />❑ Electrical Issues <br />❑ Trenches <br />❑ Non-domestle 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: 3 Lime: Gallons e; ,�� Plowed: ❑Yes -171 -No, <br />Time: f 11 Temperature: �u3 pH:i i , . > 12`-0- <br />Time: r r, Temperature: pH: ; . >12 0 <br />WOOM <br />Aiggg, <br />Or W40 <br />