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<br /> What methods were used to make the�leterminations for the compliance inspection� ' >'.�� ?' --
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<br /> Please attach the followine:
<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[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 constr�ction,abuse of the system,inadequate maintenance,or future water osage.
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<br /> Inspector's name(pnnt) ,l:_F"`� :�_��;r-:,_. c.;� Phone , ,:-,r_, �;r �.. a ^':v'-^-r"�t""'.
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<br /> License and/or Registration Number �tj�"� Address r�_`,.�..�r`.= _.�'h° .#�.. -.�5c^L.--�% ��'C j+''�S�f�:f
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<br /> Employed by�tes�/i..' c . � �`��y"�a7'�=- Address ---�•^-s•�7';�:.
<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. _,
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<br /> Signature `�� C�,)Z� �"tts':��,.---���� Date � � �
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<br /> Unarade Criteria
<br /> Minnesota Statutes § 115.55 ("law") Upgrade Requirements
<br /> Any situation witfi the potential to i�-nmediately ard adversely affect or threaten public health or safety, must be upgra�led, replaced, or
<br /> its use discontinued within ten months of receipt of this notrce or within a shorter period of fime if required by local ordinance.
<br /> If the loca/unit of govemment with jurisdiction over the system has adopted an ordinance containing altemative/oca/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, cesspoo/, or leaching pif 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/ocal ordinance.
<br /> If the system fails to provide su�cient groundwater protection, then the local unit of govemment or its agent shall order that the system
<br /> be upgraded, replaced, or its use disconfinued 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 leasf hvo 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 defrned in law.
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