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DVANE*� <br />Septic Service, LLC <br />1205 LaBeaux Ave NE <br />St. Michael, MN 55376 <br />DATE �4 —Z <br />Maintenance Inspection Form <br />MP Lic. # 654 <br />Maintainer Jim <br />O Duane <br />D Nick <br />• Phone: 763-497-2764 <br />• Email: duaneseptic@centurylink.net <br />Pumping Fee: <br />Tank #2 ❑ Yes OK0 <br />Name: <br />❑ Structural integrity <br />IIVVVIIit <br />Long Pull Fee: b <br />❑ Risers leaking <br />Address: <br />❑ Risers leaking ❑ Elevated drainfield <br />Other Repairs: 4- iD+ IT` <br />❑ Baffles <br />City/State/Zip: <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />C•JJ` JL4 <br />o r -o .,A o <br />❑ Non-domestic waste ❑ Ponding/Surfacing <br />Total Cost of Service:- <br />y60 <br />Payment Method: ❑ Check ❑ Cash <br />❑ Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is damaged, <br />designed operating depth <br />designed operating depth <br />cracked, unsecured, or appears to be <br />Septic/holdingink #1 <br />structural) <br />unsound <br />Gallons: /-7,jU S lir, <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />❑d1�o <br />❑ Septic/holding Tank #2 <br />Gallons: <br />❑ Yes <br />❑ No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />❑ Pretreatment Tank <br />Gallons: <br />❑ Yes <br />EI No <br />❑ Yes ❑ No <br />❑ Yes <br />❑ No <br />I�-Purrlp Tank <br />❑ Yes <br />C'No <br />I <br />Gallons: <br />--]Yes 0 No <br />❑ Yes <br />e- 0 <br />How Accessed: aintenance HoleScum/Sludge Measured' Maintenance Holes Securely Replaced: Reason For Pumping: <br />El Other (see attached) ❑ Yes 4j o la� ❑ No <br />Did you Identlry an peratlonal Issues or unsafe conditions while assessing the sewage tanks in this system, I.e., <br />ed tanks. miscinn hnfFloc hrnleon -a mr, 7 ra — � int. <br />Tank #1 ❑ Yes No <br />Tank #2 ❑ Yes OK0 <br />__...-- ----- --. .. <br />Pump Tank ❑ Yes E11 14 -o System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity ound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking ❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles ❑ Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domestic waste <br />❑ Electrical issues ❑ Trenches <br />❑ Non-domestic waste ❑ Ponding/Surfacing <br />❑ Effluent Filter/screen ❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Disposal: ❑ Land Application: ❑ Wastewater Treatment Plant <br />Disposal Site: Lime: <br />Gallons <br />Plowed: ❑ Yes <br />❑ No <br />Time: <br />Temperature: <br />pH: <br />>12 ❑ <br />Time: <br />Temperature: <br />pH: <br />>12 0 <br />