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EIIde Septic Service, LLC <br />24910 Territorial Road • Rogers, MN 55374 <br />Phone: 763-4284489 • e-mail: info(ri�endeseptic.com <br />Maintenance Inspection Form <br />MPCA License #: L2654 �, , Maintaitxer name: ❑ Tristanl!Brandon ❑ Scott <br />❑ Dvlan ❑ Keven <br />Date: <br />Invoice <br />Name: <br />Description: <br />Address: _ <br />Total Cost of Service: <br />CitAltocvzip: <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />TAok (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance bole: ever is <br />❑ Structural integrity <br />designed operating <br />designed.operating <br />damaged, cirs>t A: <br />❑ Risers leaking <br />depth , <br />depth <br />unsecured, or Opp .to be <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />structurain- <br />JEi4eptic/holding Tank #1 <br />❑ Yes Y.No <br />❑ Yes A5No <br />❑ Yes )KNo <br />Gallons: Logo <br />❑ Non-domestic waste <br />❑ Ponding/surfacing <br />FLSeptic/holding Tank #2 <br />❑ Yes �0. No <br />❑ Yes ,LNo <br />❑ Yes Az�0 <br />Gallons: jCW <br />Cleaned? ❑ Yes ❑ No <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />A5tump Tank <br />❑ Yes J -NO <br />❑ Yes Mio <br />❑ Yes J(No <br />Gallons: tft <br />Did you measure the accumulation of scum and sludge? kYes ❑ No <br />If the maintenance hole was used, were covers secured in place? *Yes ❑ No <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, explain in comments below. <br />Tank 41 ❑ Ye No <br />Tank #2 ❑ Yes,4&No <br />Pump Tank ❑ Yes'g.,No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />emound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfeld <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: Nemred St 4/I►. ' <br />.Y# of stud A% r� tla� a.)"- <br />Is a mound cleaning recommended at this time: 0 Yes -OkNo Next Service: 0 1 yr IK2 yr 13 3 yr <br />