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<br /> What methods were used to make the determinations for the compliance inspection? ✓ � - .Q� -- ,/,,ft
<br /> Please attach the following:
<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 area,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 ordinance that are 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 are 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 /> Inspector's name(print) �^+/ 1 +eF''�a, Phone
<br /> License and/or Registration Number ZIP -_ Address
<br /> Employed by o.16a1 ► � Address Any
<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 c Date ��" ..rte—® ✓
<br /> v
<br /> Upgrade Criteria
<br /> Minnesota Statutes § 115.55 ("law") Upgrade Requirements
<br /> Any situation with the potential 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 shorter period of time if required by local ordinance.
<br /> If the local unit of government with jurisdiction over the system has adopted an ordinance containing alternative local standards, the
<br /> existing system must 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, the 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 sufficient groundwater protection, then the local unit of government or its agent 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 two feet of design soil separation, then the system need not be
<br /> upgraded, repaired, replaced, or its use discontinued, notwithstanding any local 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 establishments
<br /> as defined in law.
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