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Ende Septic Service, I.,LC <br />24910 Territorial Road • Rogers, MN 55374 <br />Phone: 763-428-4489 • e-mail: <br />MPCA License #: 1,2654 <br />60 Maintenance ❑ Emer2encv ❑ Other <br />Maintenance tnspection Form <br />Maintainer name: ❑ Tristan Brandon ❑ Scott <br />❑ Dylan ❑ <br />Date: --. <br />Invoice <br />Name: i <br />cl <br />Description: <br />Address: ` j <br />Total Cost of Service: r f <br />City/State/Zip: Malle` <br />Payment Method: ❑ Check ❑ Cash ❑ Credit <br />Aa.veyt <br />CJ __. <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 b <br />❑ Baffles <br />❑ Baffles <br />❑ Baffles <br />structurally sound <br />kSeptic/holding Tank #1 <br />❑ Yes No <br />❑ Yes l"No <br />❑ YesN0 <br />Gallons:] r� <br />❑ Non-domestic waste <br />❑ Ponding/surfacing <br />Septic/holding Tank #2 <br />❑ Yes�No <br />❑ Yes RNo <br />❑ Yes •�'No <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 �"o <br />❑ Yes KNO <br />❑ Yes ANo <br />Gallons: <br />Did you measure the accumulation of scum and sludge? Yes ❑ No <br />If the maintenance hole was used, were covers secured in place? Yes ❑ No <br />Did you identify any operational issues ar unsafe conditions while assessing Ilse sewage tanks in this system, le., <br />cracked tanks, missing baffles, broken covers, etc.? 7fso, explaln in comments below. <br />Tank #1 ❑ Yes 610 <br />Tank #2 ❑ Yes K -No <br />Pump Tank ❑ Yes l No <br />System <br />❑ Structural integrity <br />❑ Structural integrity <br />❑ Structural integrity <br />KMound <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: <br />Is a mound cleaning recommended at this time: 0 Yes b No Next Service: 0 1 yr ❑ 2 yr.A'3 yr <br />