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Ende Septic Service, LLC <br />24910 Territorial Road • Rogers, MN 55374 <br />Phone: 763-4284489 • e-mail: infoAvendeseptic. coin <br />MPCA License #: L2654 <br />Maintenance Inspection Form <br />Maintainer name: ❑ Tristan ❑ Brandon ❑ Scott <br />f'i`-nuInn (-1 Kavan <br />Date:, <br />�_ � €���; � i <br />oo <br />Invoice <br />Name: <br />Description: <br />Address;' <br />Total Cost of Service: <br />City/State/Zip: <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 <br />❑ Structural integrity <br />designed operating <br />designed operating <br />damaged, cracked, <br />❑ Risers leaking <br />depth <br />depth <br />unsecured, or appears to be <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />structurally sound <br />El;;Septic/holding Tank #1 <br />❑ Yes -❑"No <br />❑ Yes `-O No <br />❑ Yes 'El -No <br />Gallons .'f <br />❑ Non-domestic waste <br />❑ Ponding/surfacing <br />❑`1 eptic/holding Tank #2 <br />❑ Yes &❑_ -No <br />❑ Yes - EfNo <br />❑Yes C� No <br />Gallons: <br />Cleaned? ❑ Yes ❑ No <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />13 Pump Tank <br />E3Yes O'No <br />ElYes 1[No <br />❑ Yes ❑-N` o <br />Gallons: ; <br />Did you measure the accumulation of scum and sludge? ID -Yes ❑ No <br />If the maintenance hole was used, were covers secured in place? -ErYes ❑ No <br />Didyou 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, explain in comments below. <br />Tank #1 ❑ Yes ❑'No <br />Tank #2 ❑ Yes,,E1`No <br />Pump Tank ❑ Yes'❑"No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non-domestic waste <br />❑ 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 />Is a mound cleaning recommended at this time: 0 Yes 0 No Next Service: 0 1 yr 0 2 yr -b.3 yr <br />