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Ende Septic Service, I.,LC <br />24910 Territorial Road - Rogers, MN 55374 Maintenance Inspection Form <br />Phone: 763-429-4489 - e-mail: a <br />MPCA License #: 1,2654 'Maintainer name: ❑ Tristank3randon ❑ Scott <br />rilA/(oit�tnnannn n Tiryllsl'(lPllf`.\/ i—} ("lthr��• a /_ "I _e�lF1 nvkin El <br />Date: — IS— 2, <br />Invoice <br />Name -Description: <br />j <br />Address: _ cj/ � <br />Total Cost of Service: � T <br />Cit),/State/Zip: <br />Payment M14 *C eck ❑ Cash 2��j <br />16 / /ter rr / er 6 <> l /- -J <br />,rank (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 tappear$ to be <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />structurally sound <br />Septic/holding Tank #1 <br />❑ Yes No <br />❑Yes yl No <br />❑Yes ! No <br />lions; <br />\ <br />l <br />Septic/holding Tank #2 <br />❑ Yes No <br />❑ Yes I No <br />❑ Yes R(No <br />Jallons: <br />Cleaned? ❑ Yes ❑ No <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />❑ Pump Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Did you measure the accumulation of scum and sludge? Yes ❑ No <br />Ifthe maintenance hole was used, were covers secured in place? tYes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks its this system, ie., <br />cracked tanks, inissing baffles, broken covers, etc.? Ifso, ewplain its comments below. <br />Tank #1 ❑ Yes kNo <br />Tank #2 ❑ Yes ,(fNo <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 kNo Next Service: 0 1 yr 0 2 yr 46 yr <br />