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Insuect Minnesota &�°fMidwest Soil Testing � �, 5¢, .,� Subsurface Sewage Treatment System Owner/Property Information ° �-- This information will be used for the purpose of conducting an MPCA Compliance Inspection. Date of Ins ection: Jul 27, 2017 Time: 8:30 AM Pro e Address: 315 Hollander Rd, Orono, MN Zi : 55391 Property Owner: Roger& Elizabeth Fazendin Phone: Tank s Tank(s)Material Soil Treatment Svstem Other �Septic 3 ❑Fiberglass ❑Rock trench ❑Alternative system ❑Aerobic ❑Plastic ❑Gravelless trench ❑Experimental system �Lift ❑Metal ❑Chamber trench ❑Cesspool system ❑Holding �Concrete ❑Seepage bed ❑Other system ❑Other: ❑Block �Mound ❑Other ❑At-grade Are the tank maintenance covers accessible? �Yes ❑No *If no,proper maintenance must be performed through the maintenance holes. Maintenance hole covers should be made accessible to the ground surface to facilitate access and proper maintenance of the system. Year house built: 1984 Year se tic installed: Tank size ( als. : How lon has seller owned the ro e ? Number of residents in home? Number of bedrooms? 5 Are all floors drained b ravi ? Y Garba e dis osal? Whirl ool bath? More than one s stem laund , etc. ? Does this property have any footing drain tiles connected to the septic system? Are any buildings on this property such as garages or out-buildings connected to this system? Are there any additional systems on this property serving other buildings? Location of se tic s stem on lot?Northwest Side Location of water well on lot? South Side Is the well a dee well?Y Have you ever experienced any problems with the system such as: tree roots, sewage back-ups, surfacing of sewage onto the ground, septic tank overflowing, etc.; or have any repairs been made to the system? If yes, explain: When was the s stem last um ed? Name of um er: How often um ed in revious ears? Is s stem on a monitorin lan? Have ou received notices from an overnment a enc concernin this s stem? Is our ro e located in a shoreland mana ement area? Y Do you have any additional information that should be given to the new owner? I hereby certify that the above information is correct to the best of my knowledge. I also understand that if the system is considered "non-compliandfailing" per MPCA rules, that the inspector must by law submit a copy of this report to the local government unit within 15 days of the date of inspection completion. I also agree that unless otherwise noted in this report,that I/we are ultimately responsible for payment of all fees for all work performed relative to this inspection by Inspect Minnesota and Midwest Soil Testing. Owner/Occupant: Date: