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Ende Septic Service, LLC <br />24910 Territorial Road • Rogers, MN 55374 Maintenance inspection Form <br />Phone: 763-428-4489 • e-mail: yyy <br />MPCA License #: L2654 Maintainer name: ❑ Tristan til Brandon ❑ Scott <br />Maintenance ❑ Emergency / <br />❑ Other L ` ❑ Dylan ( ❑ <br />Date: u <br />Invoice <br />Name: av1 <br />Description: <br />Address: Q ' J <br />Tota) Cost of Service. 37,4� <br />City/State/Zip: a <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 />designed operating <br />designed operating <br />damaged, cracked, <br />depth <br />depth <br />unsecured, or appears to be <br />structurally sound <br />Septic/holding Tank #1 <br />❑Yes �INo <br />❑Yes kNo <br />❑Yes *,No <br />Gallons: <br />❑ Non-domestic waste <br />❑Ponding/surfacing <br />XaSeptic/holding Tank #2 <br />11 Yes I No <br />❑Yes IWo <br />11 Yes '�No <br />llons: <br />Cleaned? ❑Yes ❑ No <br />❑ Pretreatment Tank <br />❑Yes ❑ No <br />❑Yes ❑ No <br />❑Yes ❑.No <br />Gallons: <br />tPump T <br />❑Yes �1.N0 <br />❑Yes *No <br />❑Yes 4 No <br />allons: <br />Did you measure the accumulation of scum and sludge? <br />If the maintenance hole was used were covers secured in place? <br />P <br />es❑ No <br />es ❑ No <br />Did you idenHjy any operaiioxal issues or unsafe conditions while assessing the sewage tasks in this system, ie., <br />cracked tanks, missing baffles, broken covers, etc.? If so, <br />explain in comments below. <br />Tank #1 ❑Yes No Tank #2 El Yes No Pump Tank ❑ Yesilg(No System <br />❑ Structural integrity ❑Structural integrity ❑Structural integrity Mound <br />❑ Risers leaking ❑Risers leaking ❑Risers leaking levated drainfield <br />❑ Baffles ❑Baffles ❑Baffles ❑Pressure bed <br />❑ Non-domestic waste ❑Nnn-domestic waste ❑Electri <br />Comments: <br />Is a mound cleaning recommended at this time: ❑Yes ik1lo Next Service: 0 1 yr 0 2 yr AQ <br />yr <br />cal 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: ❑Yes ik1lo Next Service: 0 1 yr 0 2 yr AQ <br />yr <br />