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�: <br /> � . �. ��innesota Pollution Control Agency (MPCA) <br /> ` Inspection Form for Existing Septic System <br /> 4 <br /> DATE OF: Ms�v S. 1999 WEATHER ONDTTIONS• Qvenast itnd 62 ISTS PER'ViIT i# 2368 <br /> REASON FOR �VSPECTION IDENTIFICATION <br /> () BeGroom of 8ath Additio❑ Proputy Owncr(s) Jaue Blanch Phone <br /> () Va;iance Sitc Addr�ss 1�80 Freach Creek Drivo City Orono <br /> () Complamt Zip Code 55391 Coanty Htnngpin <br /> (X1 Prvperty Transfa Fire Number Township Name <br /> () Ot.irr Is rystcm opened up? No Full Partial <br /> SYSTEM <br /> Has tinlc(s)ever been pumped'! Yes Yeir System Buiit: 1989 <br /> If yes,how ofttn? Ever��othcr vear For whai rea5on:�routincly_basemeut.backup_sluggish plumbing_ <br /> Usage: X dwciling_ocher establishment seasonal_othcr No of Bedrooms 3 No.of occupants� <br /> Watsr we appiiances: X Clotbes w•asher ?� Dis6washer X Garbage disposal X Whirlpool bath 3�Watu softenec 7�H�unidifier in fum <br /> Nearat Surf�ce Water to�ystem; feet from which type of water; m�a iake stream othcr <br /> SEWER SYSTE'.H COMPONE'.YTS: <br /> 7'ank(e) Tank M�teria! Soil Trcatroent Svstem Q�}�r <br /> 2 Septic Tnnk Fibergiass X Rock trench AitannLive system(type) <br /> Aaobic tank Plastic Gravclless trench _Experimental systcm(type) <br /> 1 Pump tank Mctai Chambcr trcnch _other(tyPe) <br /> _Holding tnnk X Coucaete _Seepage bed <br /> �Other _Moun�d <br /> At-gradc <br /> Tink{s)size: 2-]000 Qallon taoks Soii treatment area siu(a): 660 square feet ot rock btd area <br /> COMPLIANCE L'�ISPECTIONt <br /> Is kbert.or ha�there evtr betn:■_nv tvidmce of: Rcspgn�g Explain <br /> Discharge of sewage to the ground surface' NO <br /> Discharge of scwage to surfece watcr? NO <br /> A seepagep,j��well,ccsspool,a l�sch�pit? NO <br /> Less thanip ect of certical separation b�wcen the soil n0 ,�n/�,��1,�„� ob�����„ �,,, s' <br /> �ea�xnt s}stcm bouom and saturated soil a bodrock? <br /> Sewagc back up into the dwelling or other establishment? NO <br /> s�n�uons�chc Pocom�a�co►rnn,��c�h�and��s��y ir�a�c, <br /> or tt�reaten public he8ith or safety? NO <br /> •if}�es w�s answtrcd fa any of the abo�e Q�estion,the s}st�m is failing according to Minnesota Rules.ch. 7080.0060. <br /> STATG'S OF THE SYSTEM <br /> . � <br /> Bbsed on Che compliance inspection condu abor•c s tem status is .-� , therefore, <br /> This documcnt is a �'1 � C�. � �.C,[� <br /> CERTIFICATIOti <br /> I hacby c,ersf}•as a state of Minncsota liccased Inspeccor,Designa I,or Qualificd Employce that my obsen�ations recordcd on this form <br /> arc accuratc�s of the datc at the cop of this fam for the sitc stnted abo��e. No deta-mined of future hydraulic performance can be made due <br /> to unlmow�n conditions during system corsuvction,future water usage over the life of the s}�stem,abuse of the system,and/or inadeguatt <br /> maintrnance all of w•hich wil]adrersety affcct the life of tho sysum. <br /> ,...,.�.-,--- - <br /> �. ,._.�._.. — <br /> Inspecxor Davc Hormann License# 644 <br /> �, '�:i�,Y 1 0 i���� <br /> ', <br /> � - ., <br /> r I � -- - Gii'r �;�- �,-: .:.� <br /> Sienu��te l_ � �� T�ie Mt�v S 1999 <br /> �/ <br />