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Wh�t methods were used to make the determinations for the compliance inspection��;'�
<br /> �, c/� fr ._ ,, .
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<br /> Please attach the followina:
<br /> 1) Site sketch. Suggested items for drawing include:Well,wefl 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'sname(print)_,.'����< �� '.�c� �.r�:-1`,-��,�,�� � Phone
<br /> License and/or Registration Number ��'y� Address ��';,.��,".�� �.►'�-�:.�e, ., � c��'G'=-�,
<br /> Employed by,, !.'� . ; ' _ ��..'-EF . Address � �' �s�_X
<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 l/� ,r.r-d t'�'�'``:�'�,�„�/�.�-.c. .- «�� Date � ,,�''�` �' �.�''
<br /> ,:
<br /> Upqrade Criteria
<br /> Minnesota Statutes § 115.55 ("law") Upgrade Requirements
<br /> Any situation witt�the potential to i,-nmediately ard adverse/y 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 fime if required by local ordinance.
<br /> If the local unif of govemment with jurisdiction over the system has adopfed an ordinance containing altemative local standards, the
<br /> existing system must comply with the ordinance. If the system does not comp/y 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 fhe local unit of govemment with jurisdiction over the sysfem 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 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 discontinued within fhe fime required by►ule or the local ordinance.
<br /> If an existing system is nof 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 sfrict. This does not apply to
<br /> systems in shoreland areas, wellhead protection areas, or those used in connection with food, beverage, and lodging esfablishmenfs
<br /> as defined in Iaw.
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