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Ende Septic Service, LLC, MPCA Lic #L2654 <br />24910 Territorial Road • Rogers, MN 55374 <br />Phone: 763-4284489 <br />email: infona,endeseptic.com <br />Maintenance Inspection Form <br />❑ TristanABrandon ❑ Scott ❑ Kurt ❑ Robert <br />p11 Maintenance ❑ Emergency ❑ Other /-�sposa�Ircation: 14 Land ap ❑ Treatment plant <br />Date: g— 21 — Z`j <br />Invoice <br />Name: �- t. <br />h <br />o <br />Description: <br />Address: $ GHG( <br />Total Cost of Service: <br />City/State/Zip: C- #_Q <br />I S p,i 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 />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 4tNo <br />❑ Yes ((No <br />❑ Yes ) No <br />Gallons: 1.000 <br />In Septic/holding Tank #2 <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Pump Tank <br />❑ Yes &No <br />❑ Yes Ao <br />❑ Yes ANNo <br />Gallons: a oo <br />Did you measure the accumulation of scum and sludge? &Yes ❑ No <br />Access point: tACover/maintenance hole; if so, were covers secured in place? t Yes ❑ No <br />Access point: =spection pipe; if through pipe, did homeowner sign off <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 #1 ❑ YesC"o <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ YeA No <br />System <br />❑ Structural integrity <br />❑ Structural ' egrity <br />❑ Structural integrity <br />Almound <br />❑ Risers leaking <br />❑ Risers le ing <br />❑ Risers leaking <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffle <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non -domestic waste <br />❑ Non- omestic waste <br />❑ Electrical issues <br />❑ Trenches <br />❑ Non -domestic waste <br />❑ Ponding/surfacing <br />❑ Effluent filter cleaned? <br />❑ Other: <br />❑ Yes ❑ No <br />Comments: <br />4,7 fove Oh <br />