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Ende Septic Service, LLC, MPCA Lic #L2654 <br />24910 Territorial Road • Rogers, MN 55374 <br />Phone:763-428.4489 <br />email: info(a)endeseptic.com <br />Maintenance Inspection Form <br />❑ Tristan iftrandon ❑ Scott ❑ Zach ❑ Robert <br />Maintenance ❑Emergency ❑Other G ,D}sposp cation: ❑ Land ap 4 Treatment plant <br />Date: <br />Invoice <br />Name: e eve 161 e / <br />Description: �� �/�r�o �Lq <br />` <br />Address: it2 <br />� 7S.00 <br />Total Cost of Service. <br />City/State/Zip: &jf� <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />r< <br />tVt4 <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 />V§eptic/holding Tank #1 <br />t <br />❑ Yes \ <br />Elmo Yes 01 No <br />❑ Yes lyNo <br />C Gallons: �s <br />Septic/holding Tank #2 <br />❑ Yes q No <br />❑ Yes Ui No <br />❑ Yes I No <br />f Gallons: <br />l <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Pump Tank <br />❑ Yes I No <br />❑ Yes ANo <br />❑ Yes rj`!No <br />Gallons: <br />Did you measure the accumulation of scum and sludge? 4T Yes ❑ No <br />Access point: CKLover/maintenance hole; if so, were covers secured in place? BCYes ❑ No <br />Access point: sB'ispection pipe; if through pipe, did homeowner sign off ?LUo� <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 kNo <br />Tank #2 ❑ Yes delNo <br />Pump Tank ❑ YeLAQ 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: 4) , S ;JavptZ c>k <br />