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Ende Septic Service, LLC, MPCA Lic #L2654 <br />24910 Territorial Road • Rogers, MN 55374 <br />Phone: 763-4284489 <br />email: info(o)endeseptic.com <br />/`J Maintenance ❑ Emergency ❑ Other <br />Maintenance Inspection Form <br />❑ Tristan ❑ Brandon ❑ Scott ❑ Zach ❑ Robert <br />0 AI,y 3S R <br />Disposal location: ❑ Land ap ❑ Treatment plant <br />Date: `] — 22- 24� <br />Invoice <br />Name: z L <br />Description: &I <br />V d J a9c <br />Address: too <br />aI4hC1 <br />Total Cost of Service: <br />City/State/Zip: e j(Ce 15T0 J) <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 ZNo <br />❑ Yes J/J No <br />❑ Yes ✓rJ No <br />te <br />Gallons: 1opC) <br />(27 Septic/holding Tank #2 <br />❑ Yes ,PI No <br />❑ Yes No <br />❑ Yes No <br />Gallons: ((9pC.) <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Pump Tank <br />❑ Yes ;a No <br />❑ Yes XNo <br />❑ Yes eeNo <br />Gallons4#01 'o-SD)p <br />Did you measure the accumulation of scum and sludge? )eYes ❑ No <br />Access point: / Cover/maintenance hole; if so, were covers secured in place? /Yes ❑ No <br />Access point: ❑ Inspection pipe; if through pipe, did homeowner sign off ? ❑ 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.? If so, explain in comments below. <br />Tank # 1 ❑ Yes No <br />Tank #2 ❑ Yes Z No <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 cleaned? <br />❑ Other: <br />❑ Yes ❑ No <br />Comments: S I U� Gt GLCC u M It 14 tk"p 11 2 i n c l,cS <br />