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Ende Septic Service, LLC <br />24910 Territorial Road - Rogers, MN 55374 <br />Phone: 763-42.8-4489 - e-mail: <br />MPGA License #: 1,2654 <br />kMaintenance ❑ EmerRency ❑ Other <br />Maintenance -Inspection Form <br />Maintainer name: ❑ Tristauy Q Brandon ❑ Scott <br />❑ Dylan ❑ <br />Date: <br />Invoice <br />Name: jam_ <br />{ sa <br />Description:,cc , S `` 1 s <br />Address: 1 t t/ <br />Total Cost of Service. 7 © d <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 18 <br />❑ Structural integrity <br />designedoperating <br />designed operating <br />damaged, cracked, <br />D Risers leaking <br />depth <br />depth <br />unsecured, or appears to b <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />structurally sound` <br />Septic/holding Tank #1 <br />❑ Yes No <br />❑ Yes tNo <br />❑ Yes I PNo <br />Gallons: d <br />❑ Non-domestic waste <br />❑ Ponding/surfacing <br />t Septic/holding Tank #2 <br />D Yes to <br />D YesNo <br />❑Yes ,81 No <br />i(xallons: <br />Cleaned? ❑ Yes ❑ No <br />El Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />ump Tank <br />k <br />D Yes ANO <br />❑ Yes ANO <br />❑ Yes 1 N0 <br />lons: <br />Did you measure the accumulation of scum and sludge?Yes ❑ No <br />If the maintenance hole was used, were covers secured in place? PYes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing Ilse sewage tanks in this system, i.e., <br />cracked tanks, missing baffles, broken covers, etc.? 1f'so, explain lit comments belom% <br />'Tank #1 ❑ Yes WINo <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ Yes N No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />ound <br />D 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 t$I No Next Service: 0 1 yr 0 2 yr"3 yr <br />