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Ende Septic Service, LLC <br />24910 Tentorial Road • Rogers, MN 55374 <br />Phone: 7634284489 • e-mail: info(dendeseptic.com <br />MPCA License #: L2654 <br />Maintenance Inspection Form <br />Maintainer name: ❑ Tristan,16OBrandon ❑ Scott <br />❑ Dvlan ❑ Keven <br />Date: 9 . o-), 1? - 02 <br />Invoice <br />Name: �A�+ .A n <br />r <br />Description: <br />Address: 36 9 W w 1\ <br />Total Cost of Service: <br />City/State/Zip:fDnC <br />Payment Method: ❑ Check ElCash El Credit <br />Tank (check if present) <br />Tank leaks below the <br />Tank leaks above the <br />Maintenance hole cover is <br />❑ Structural integrity <br />designed operating <br />designed operating <br />damaged, cracked, <br />❑ Risers leaking <br />depth <br />depth <br />unsecured, or appears to be <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles❑ <br />structurally sound <br />�J Septic/holding Tank #1 <br />❑ Yes �No <br />❑ Yes �VNo <br />❑ Yes PNo <br />Gallons: <br />❑ Non -d <br />❑ Ponding/surfacing <br />eptic/holding Tank #2 <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallo <br />Cleaned? []Yes ❑ No <br />❑ Pretrea ent Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ElNo <br />Gallons: <br />❑ Pump Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Did you measure the accumulation of scum and sludge? ❑ Yes 51n No <br />If the maintenance hole was used, were covers secured in place? 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 #I ❑ Yes )l No <br />Tahk#2 ❑ Yes ❑ No <br />np Tank ❑ Yes ❑ No <br />System <br />❑ Structural integrity <br />❑ Stru ral integrity <br />❑ St 'ural integrity <br />❑ Mound <br />❑ Risers leaking <br />❑ Risers 1 ing <br />❑ Risers\iss <br />❑ Elevated drainfield <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles❑ <br />Pressure bed <br />❑ Non-domestic waste <br />❑ Non-domesti aste <br />❑ ElectriPTrenches <br />❑ Non -d <br />❑ Ponding/surfacing <br />❑ Effluen <br />❑ Other: <br />Cleaned? []Yes ❑ No <br />Comments:I <br />�`(`�-in'�e11aT\Gc- E�wm��-9, No t SSltics t �n`ti .e <br />Is a mound cleaning recommended at this time: 0 Yes ❑ No Next Service: 0 1 yr ❑ 2 yr 0 3 yr <br />