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Ende Septic Service, LLC <br />24910 Territorial Road • Rogers, MN 55374 <br />Phone: 763-428-4489 • e-mail: info(Wendeseptic.com <br />MPCA License #: L2654 <br />Maintenance Inspection Form <br />Maintainer name: ❑ Tristan JW Brandon ❑ Scott <br />❑ Dylan ❑ Keven <br />Date: I I- 01 a. a III <br />Invoice <br />Name: -DtaV e, �.i� � l l S <br />Description: <br />Address: I 10 cl W 4:7a Y7n <br />Total Cost of Service: <br />City/State/Zip: Q COn O Il N <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 />Septic/holding Tank #1 <br />❑ Yes No <br />❑ Yes No <br />❑ Yes PNo <br />Gallons: / 0 0'0 <br />❑ Non-domestic waste <br />❑ Ponding/surfacing <br />Septic/holding Tank #2 <br />❑ Yes No <br />❑ Yes 1�PNo <br />❑ Yes No <br />Gallons: / 0-010 <br />Cleaned? ❑ Yes ❑ No <br />❑ Prtri eatment Tank <br />s <br />❑Yes o <br />❑ Yes ❑ No <br />Gallons. <br />§iLPump Tank <br />❑ Yes 1C3No <br />❑ Yes ;P1110 <br />❑ Yes I'lo <br />Gallons: 50 0 <br />Did you measure the accumulation of scum and sludge? ❑ Yes )I No <br />If the maintenance hole was used, were covers secured in place? JO 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.? /f so, explain in comments below. <br />Tank #1 ❑ Yes `C No <br />Tank #2 ❑ Yes ]sd No <br />Pump Tank ❑ Yes 0 No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />Rmound <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 />1 <br />Is a mound cleaning recommended at this time: ❑ Yes R No Next Service: 0 1 yr 0 2 yr �O yr <br />