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AUGr27-a0�8 02:36P FROM:FESSEL ENU 1 507 362 8829 T0:19522494616 P.3�5 <br /> "OTHER"ON-SCfE SEWAGE TREATMENT SYSTEM IYOTIFICATION <br /> 1. The attached system design is classified as an"OTHER"system according to Minnesota Rules,Chapter <br /> 7080,individual Sewage Treatrnent Systems Standards,Revised September 2002. <br /> 2. The undersigned designer assumes responsibility fo�the design,worlQnanship and material used for the <br /> _....... attached system-desiga�— — _ <br /> 3. Le Sueur County assumes no responsibility for the performance of the attached described system. <br /> MOMTORIIVG PLAN (ATTACX ADDITIONAL SNEETS AS NEEDEDJ RESPONSIBLE PARTY <br /> REQUiRED: FLOW READING AND VISUAL CHECK FOR SEEPAGE HOIV�OWNER* <br /> B[ANNUALLY(APRIL,OCTOBEI� <br /> RECORDS SUBMITTED TO COUNTY BY NOVEIV�ER 15'�" HOMEOWNER* <br /> i <br /> MAINTENANCE CONTRACT–A�ROefC r�rhrENT uivlTs Onl[Y . HO[vv�OWNfiR+ <br /> (RECOMMEND QUARTERLY MAINTENANCE SBRYICE) <br /> � <br /> "Homeowner c�y choose to contract out for these services. <br /> NRT[GATLON PLAN (A7TACAAD PI70NALSNEE7SASNF.EDED1 <br /> . . <br /> Ftow Measurement Type: D IOm R� ,� <br /> PARCEL ID: Township ' Rauge Section <br /> Designer Name and MPCA Liceuse Number Property Owner Name <br /> Desigr►e�r Signature Properry Owner Si�ature , <br /> [hereby acknowtedge that I a4sumc responsibiliry for f hereby acknowledge that I have read the above <br /> tlu atteched"Othe�'ISTS design and fully�nderstand my requirements of tfie Monitoring Pien and fully understand <br /> my responsibilities as stated in the above MoniWring� my responsibilities as a homeowner of the attached <br /> Mitigstion Plens. "Other"ISTS. <br /> Date Date <br /> A copy of this form and eny aaachments will be made available upon�ques� <br /> and will he Icept on 81e at the Le Soew County finviroemental Servicas Office. <br /> PAGE 2 OF 2 <br />