HomeMy WebLinkAbout05-18-22 Septic Maintenance Inspection FormEnde Septic Service, LLC
24910 Territorial Road • Rogers, MN 55374
Phone: 763-428-4489 • e-mail: into(a,endeseptic.com
Maintenance Inspection Form
MPCA License #: L2654 Mainta�er arae: ElTristanrandon ❑ Scott
G / ❑ Dvlan ❑ Keven
Date: u
Invoice
Name: ,,- j An
Description:
Address; ,� Q �T��S
Total Cost of Services"/Z. S"
designed operating
Payment Method: El Check ❑Cash ❑Credit
Tank (check if present)
Tank leaks below the
Tank leaks above the
Maintenance hole cover is
❑ Structural integrity
designed operating
designed operating
damaged, cracked,
❑ Risers leaking
depth
depth
unsecured, or appears to be
❑ Baffles
❑ Baffles
❑ Baffles
structurally sound
Septic/holding Tank #1
❑ Yes l No
❑ Yes [� No
❑ Yes C 'No
allons: GQ
❑ Non-domestic waste
❑ Ponding/surfacing
fSeptic/holding Tank #2
❑ Yes [�l No
❑ Yes f�l No
El Yes No
allons: �d
Cleaned? ❑ Yes ❑ No
1
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
Pump Tank
❑ Yes A No
❑ Yes X No
❑ Yes �l No
Gallons:
Did you measure the accumulation of scum and sludge? L Yes ❑ No
If the maintenance hole was used, were covers secured in place? ,-Yes ❑ No
Didyou identify any operational issues or unsafe conditions while assessing the sewage tanks in this systerrr, i.e.,
cracked tanks, missing baffles, broken covers, etc.? If so, explain in comments belotiv.
Tank #1 ❑ Yes 4 No
Tank #2 ❑ Yeses No
Pump Tank ❑ Yes tNo
System
❑ Structural integrity
❑ Structural integrity
❑ Structural integrity
'Mound
❑ Risers leaking
❑ Risers leaking
❑ Risers leaking
❑ Elevated drainfield
❑ Baffles
❑ Baffles
❑ Baffles
❑ Pressure bed
❑ Non-domestic waste
❑ Non-domestic waste
❑ Electrical issues
❑ Trenches
❑ Non-domestic waste
❑ Ponding/surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Comments:
Is a mound cleaning recommended at this time: 0 Yes A No Next Service: 0 1 yr 0 2 yr t3 yr