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':�,� ..r:�r.- .... . ,�,�`..�"�wa...—�-.e--— 'eeilew.`...w.��.�:n�{a�Y"f1AR1�:�'OT�'o"_�n +a... �.r'+�'t�,An '%Ri � ' MR �AlnY[.R:t M��.�'�. .
<br /> 'C I . . � .4�Ck, ��..�R-�L•�iGN�Sy .
<br /> •
<br /> What methods were used to make the determinations for the compliance inspection? ,�'�r *C)�"` --- ""
<br /> ��:.�f . �
<br /> Please attach the followin¢:
<br /> 1) Site sketch. Suggested items for drawing include:Well,well setback to system,dwelling or other establishment,tank(s),soil treatment system,
<br /> reserved soil treatment azea,curtain drain,property lines,waterways,and buried lines(those NOT installed by the utility). Include sizes and
<br /> length and approximate distances from fixed reference points such as streets and buildings.
<br /> 2) Soil boring logs,showing each horizon. Indicate the texture,structure,color,depth of each different soil type,evidence of mottling,bedrock
<br /> and standing water and whether the material is fill. Locate each boring on attached site sketch.
<br /> 3) A list of any and all requirements of the local ordina�ce that aze different than the sate requirements referred to on this form.
<br /> CERTIFICATION
<br /> A. I hereby certify that all the information I have provided regarding the individual sewage treatment system is true,accurate,and complete.
<br /> Property Owner Date
<br /> B. I hereby certify as a state of Minnesota licensed Inspector and/or Designer I or Qualified Employee Inspector and/or Qualified Employee
<br /> Designer I that I conducted an investigation in accordance with applicable requirements that accurately determined the compliance status of this
<br /> system and that my observations recorded aze accurate as of this date. No determination of future hydraulic performance has been nor can be
<br /> made due to unknown conditions during system construction,abuse of the system,inadequate maintenance,or future water usage. ,,;,
<br /> ;�.
<br /> ! '�:
<br /> Inspector's name(print) ...j,�:� �:;;�,;�"cl�'<i.e. G/ Phone ��-..��-�`—K,:��,,<�,c-- �:;.
<br /> . —� �' r .
<br /> License and/or Registration Number � Address ��,�,` �"_'�} •�'77 �t a����._. ,r':.� � �. .-;
<br /> s^ / .
<br /> Employed by i�l,c.�;�e��t,/+�..ed �� Address ��.;:,i�,»�^`.,
<br /> Valid until ,unless the system becomes an imminent threat to public health or safety as defined at Minn.R.7080.0020,subp. 19a,before
<br /> that time. �
<br /> Signature � Date " "'ti ' �` %
<br /> Uparade Criteria �
<br /> Minnesota Statutes § 115.55 ("law") Upgrade Requirements
<br /> Any situation with the potenfia!to immediately and adversely affect or threaten public health or safety, must be upgraded, replaced, or
<br /> its use discontinued within ten months of receipt of this notice or within a sho►ter period of time if required by local ordinance.
<br /> If the local unit of govemment with jurisdiction over the system has adopted an ordinance containing altemative local standards, the
<br /> existing system musf comply with the ordinance. If the system does not comply with the ordinance, it must be upgraded, replaced, or
<br /> its use discontinued according to the ordinance.
<br /> If a seepage pit, drywell, cesspool, or leaching pit exists and the local unit of govemment with jurisdiction over the system has not
<br /> adopted local standards to the contrary, fhe system is failing and must be upgraded, replaced, or its use discontinued within the time
<br /> required by local ordinance.
<br /> If the system fails to provide su�cient groundwater protection, then the local unit of govemment or its agenf shall order that the system
<br /> be upgraded, replaced, or its use discontinued within the time required by rule or the local ordinance.
<br /> If an existing system is not failing as defined in law, and has at least hvo feet of design soil separation, then the system need not be
<br /> upgraded, repaired, replaced, or its use discontinued, notwithstanding any Iocal ordinance that is more strict. This does not apply to
<br /> systems in shoreland areas, wellhead protection areas, or those used in connection with food, beverage, and lodging estab/ishments
<br /> as defined in law.
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