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Ende Septic Service, LLC <br />24910 Territorial Road • Rogers, MN 55374 Maintenance Inspection Form <br />Phone: 763-428-4489 • e-mail: into Civendeseptie.com <br />MPCA License #: L2654 amtainer name: ❑ Tristan*Brandon ❑ Scott <br />❑ Dvlan ❑ Keven <br />Date: <br />Invoice <br />i <br />Name: <br />Description: ' <br />Address: <br />24! <br />Total Cost of Service: <br />City/State/Zip: Q <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 />❑ 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 />XSeptic/holding Tank # 1 <br />❑ Yes No <br />❑ Yes �No <br />Yes }$No <br />Gallons: r <br />❑ Non-domestic waste <br />❑ Ponding/surfacing <br />kSeptic/holding Tank#2 <br />❑ Yes 4No <br />❑ Yes 4No <br />❑ Yes 4No <br />Gallons: <br />Cleaned? ❑ Yes ❑ No <br />❑ Pretreatment Tank <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Gallons: <br />Pump Tank <br />❑ Yes ANNo <br />❑ Yes No <br />ElYes INo <br />Gallons: zCQV <br />Did you measure the accumulation of scum and sludge? es ❑ No <br />If the maintenance hole was used, were covers secured in place? tyes ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, Le., <br />cracked tanks, missing baffles, broken covers, etc.? Ifso, explain in comments below. <br />Tank #I ❑ Yes kNo <br />Tank #2 ❑ Yes No <br />Pump Tank ❑ YespNo <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />k'd'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/screen <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: i?60 ✓1 / as -30 t <br />Is a mound cleaning recommended at this time: 0 YesLMo Next Service: ❑ 1 yr 0 2 yr <br />