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Cnde Septic Service, LLC <br />24910 Territorial Road • Rogers, MN 55374 <br />Phone: 763-428-4489 • e-mail: info Blend otic ptic.com <br />MPCA License M L2654 <br />Maintenance Inspection Form <br />Maintainer name: ❑lTristan%' Brandon ❑ Scott <br />❑ Dylan ❑ Kevin <br />Date: 19- ? . -��c" <br />Invoice <br />Name: /_. c 0 ri <br />Description: C <br />Address:,:t1,.� t r1 (�.` <br />Total Cost of Service: °hS <br />City/State/Zip: 6-r' f o <br />Payment Method:= ❑ Check ❑ Cash ❑ Credit <br />Tank (check if present) <br />Tank leaks beloiv 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 />Ida Septic/holding'rank #I <br />❑ Yes Q No <br />❑ 1'cs .O No <br />❑ 1'cs i~1 No <br />Gallons: IZS <br />h� /� <br />❑ Non-domestic waste <br />❑ Ponding/surfacing <br />OR Septic/holding Tank #2 <br />❑ Yes D No <br />❑ Ycs ❑ No <br />❑ Yes -e9,No <br />Gallons: I Zed <br />Cleaned? ❑ Yes ❑ No <br />❑ Pretreatment Tank <br />❑ Ycs ❑ No <br />❑ Ycs ❑ No <br />❑ Ycs ❑ No <br />Gallons: <br />QR Pump Tank <br />❑ Ycs 1 No <br />❑ Ycs �T] No <br />❑ Yes A No <br />Gallons: / Z = (. <br />Did you measure the accumulation of scum and sludge? V'Yes ❑ No <br />If the maintenance hole was used, were covers secured in place? kY, es ❑ No <br />Did you identify any operational issues or unsafe conditions while assessing the selvage tanks in this system, i.e., <br />cracked tanks, missing baffles, broken covers, etc.? !f so, evplain in continents below. <br />Tank #1 ❑ YesLJF No <br />Tank #2 ,�K7' Ycs ❑ No <br />Pump Tank ❑ Yes iallo <br />System <br />❑ Structural integrity <br />Q Structural integrity <br />❑ Structural integrity <br />AV' Mound <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Risers leaking <br />❑ Elevated drainfield <br />Baffles <br />❑ Baffles <br />❑ Baffles <br />❑ Pressure bed <br />❑ Non -do estic waste <br />❑ Non-domestic waste <br />�p <br />❑ Electrical issues <br />❑ Trenches <br />�e �c t<e <br />h� /� <br />❑ Non-domestic waste <br />❑ Ponding/surfacing <br />,c <br />❑ Effluent Filter/screed <br />❑ Other: <br />Cleaned? ❑ Yes ❑ No <br />Comments: <br />Is a mound cleaning recommended at this time: 0 Yes LI -No Next Service: 0 1 yr 0 2 yr &3 yr <br />