HomeMy WebLinkAbout10-04-2021 Septic Maintenance InspectionEnde Septic Service, LLC
24910 Territorial Road - Rogers, MN 55374
Phone: 763-428-4489 - e-mail:
MPGA License #: 1,2654
❑ Maintenance C] Ememencv ❑ Other
Maintenance Inspection Form
Ivlaintainer name: 6 Tristan ❑ Brandon ❑ Scott
❑ Dvlan ❑
Date:
Tank leaks below the
Tank leaks above the
Invoice
Name:
designed operating
Description:
Address: L�
Total Cost of Service:
City/State/Zip: W W qMtk
Payment Method: ❑ Check ❑ Cash ❑ Credit
`lank (check if present)
Tank leaks below the
Tank leaks above the
Maintenance hole cover fs
❑ Structural integrity
designed operating
designed operating
dannaged, cracked,
❑ Risers leaking
depth
depth
unsecured, or appears to be
❑ Baffles
❑ Baffles
❑ Baffles
structurally sound
❑ Septic/holding Tank #1
❑ YesglNo
❑ Yes YNO
❑ Yes No
Gallons:
'�1t
❑ Non-domestic waste
❑ Ponding/surfacing
❑ Septic/holding Tank #2
❑ Yes E� O
❑ Yes No
El PNo
Gallons;
l`
t
❑ Pretreatment Tank
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gallons:
❑ Pump Tank
❑ Yes 91W
❑ Yes 0 No
❑ Yes No
Gallons:
Did you measure the accumulation of scum and sludge?
If the maintenance hole was used, were covers secured in place?
Yes ❑ No
Yes ❑ No
Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system, i.e.,
cracked tanks, missing baffles, broken covers, etc.? Ifso, evplain In comments helow.
Tank #1 ❑ Yes No
Tank #2 ❑ Yes No
Pmup Tank ❑ Yes No
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
❑ Elech7cal issues
❑ Trenches
❑ Non-domestic waste
❑ Ponding/surfacing
❑ Effluent Filter/screen
❑ Other:
Cleaned? ❑ Yes ❑ No
Continents:
Is a mound cleaning recornmended at this time: ❑ Yes 0 No Next Service: El yr ❑ 2 yr 0 3 yr