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, Minnesota Pollution Controi Agency (MPCA) <br /> � r . ., Inspection Form for Existing Septic System <br /> DATE OF: Mav 5. 1999 WEATHER ONDITIONS• Overcast and 62 ISTS PERMIT� 2368 <br /> REASON FOR INSPECT'ION IDENTIFICATION <br /> () Bodroom of Bath Addition Propaty Owner(s) l�ae Blanch Phone <br /> () V��� Site Address 1�80 Frarch Croek Drive City Orono <br /> () Complaint Zip Code 55391 C�� ���p� <br /> (Xj Property Transfer Fire Number Township Name <br /> () Other Is system openod up? No Full Partiai <br /> SYSTEM <br /> Has taolc(s)cver been pumped? _�__ Yetr System Built: 1989 <br /> If yes,how often? Everv other year For what reesan: 3�routinely_basement backup_sluggish plumbing! <br /> Usage� J.j} dwelling_other establishment seasonal�other No of$edroams 3 No.of occupants� <br /> Water ux zppliance�: X Clothes washer }C Dishwasher J{ Garbage disposal X Whirlpool bath 3�Water softener x Humidifier in fiun <br /> Nesrat Sarface Wattr to system; feet from which type of water; river lake stream othcr <br /> SEWER SYSTEM COMM3NENTS: <br /> Tank(al Tank Matsrial �il Treatment Svstan Other <br /> 2 Septic Taak Fibergiass }C Rock trench Altomative system(type) <br /> Aerobic tanic Plastic Grevelless trer►ch _Experimental system(type) <br /> 1 Pump tanlc Metat 'Chamber trench _other(type) <br /> i Holding tank .�Cancxete _Seepagc bed <br /> _Other _Mou�d <br /> At-grade <br /> Ttak(s)size: 2-1000 Q�iion tanks Soil treatment area siu(s): 660 square ieet ot rock bed area <br /> COMPLIANCE INSPECTION* <br /> I����or ba�t_�re ever been anv evideace of• Resnonse Explain <br /> Discharge of sewage to the ground surface? NO <br /> Discharge of sewagc to surface water? NO <br /> A seepngep�t,�Y►�'etl,cesspool,or leaching pit? NO <br /> Less tlian iw�oct of vertica!separation between the soil <br /> ��s,��m����s��������k� no —�N.��►a►t/k.,� o��.r��r., ,n�� s� <br /> Sewagc bacic up into the dwelling or othtr estabtishment? NO <br /> Situations with ti�e poteirtial to immcdiately and adverscly impact, <br /> or d�r�attn public health or safety? NO <br /> •if yes was answered for any of the above question,the systam is failing according to Minnesota Rules.ch. 7080.0(160. <br /> STATUS OF THE SYSTEM <br /> Based�thc compliance inspection condu ebove s tem status is_�,.-� _, therefore, <br /> This document is a �`4 � C�, /; K,,[ <br /> CERTIFICATION <br /> I hereby certify es a state of Muinesota licensed Inspector,Designa I,or Qua[ified Employee tt►et my observations recorded on this form <br /> are accurate as of the date at the Wp of this form for the site stated above. No determined of future hydraulic performance can be made due <br /> to ucilmown conditions during sysum construction,fuiure water usage over the life of the system,abuse of the system,and/or inadequate <br /> meintenance all of which will adversely affect the lifc of the system. <br /> Inspector Dave Horniann License# 644 <br /> � � � , <br /> � <br /> i <br /> � - P �. : �.: :::�:.:,� <br /> Si¢nM�m �� nxte Mev 5 1999 <br />