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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(cbendeseptic.com <br />Maintenance ❑ Emergency ❑ Other <br />Maintenance Inspection Form <br />❑ Tristan ❑ Brandon ❑ Scott ❑ Zach ❑ Robert <br />Disposal location: ❑ Land ap ❑ Treatment plant <br />Date: "' -1 1 - " 'z;- <br />Invoice <br />Name:!_1� <br />Description: �. <br />Address: ? "' ! �� �� <br />Total Cost of Service: <br />City/State/Zip: t �� h <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 ❑ No <br />❑ Yes ❑ No <br />❑ Yes 5 No <br />Gallons:tp <br />❑ 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 />Z Pump Tank <br />❑ Yes IK No <br />❑ Yes KNo <br />❑ Yes -0 No <br />Gallons: {� <br />Did you measure the accumulation of scum and sludge? ;( Yes ❑ No <br />Access point: X 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 /J 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 CI No <br />Tank #2 ❑ Yes ❑ 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: j t.a <br />