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Home My WebLink Aboutseptic info � MinnesotaPollution Compliance Inspectian Form Cont�ol Agency k 520LafayetteRoadNonh Existing Subsurface Sewage Treatment Systems (SSTS) S�.PauI,MN55155�194 � InsCructions an page ' PdrCel number: Fo�LOcal Tracking Purposes System status: ompliant ❑Noncompllant (based on aH com liance requirements) / � ' !/. Sutnmay �orrt� ��( Property Informat9on � r �� - - Property owner name(s� l�1 Property address; � "' � Praperty owner's address(if different); __,._ _.,__..._., . County: 1n�, P perry owner phone: q�,��T/3" 33 Permi�ing authc�ity: C•1� .__,�_,_,_,.� , , �ate system const ctad: Reason fo�inspection; ___,.__._,_. „ „ System Description , Brie(system description: ��. GJ � 121 0 tJ� l.ocal pem�ii number: Number of bedroom : � Design flow rate: _� . Is the sy�stem: �� in Shorsland area? ❑Yes �No In Wellhead Protectlon Area? ❑ Yes JI�� No An U,S. Environmental Proteclion System serving a Minnesota Department � � Agency (�PA)Class V InjeCtion Well?�] Yes �No of Heath(MQH)licensed faciliry? � Yes �No Compll+��Ce $tdtU4(Based on state requirements—additiohal local requi�ements may also apply.) Based on the infonnation gathered and rsported on sttached fo�ms,the compliance status of this system is(cneck onc� �Ceniflcate of Compllance—valid until (3 yvars from date ol repo�: __,.__.__,. ... . ❑ Notice of Noncompliance- For Noncompliant systems: The reason tor non�mpliance is� ._,_.. . .. . , 7hls noncompliant system is classiffod as (check one below): Q Imminent threst co public health 8 sefiety � Failing to proteet ground water ❑ Not in compliance wiih op�rauny p�rn,� C2t'ttfiC8t1011 (Completad fonn must be submltted to the local unit of govemment within 15 days.) �hereby certify thaf all rhe necessary inlormation has been gafhered fo determine the compl;ance stalus of rh�s sysreri; �,: defermina(ion o!future syStem pe�ormence has been nar can be mede due!o unknawn Condiflons during sys�err�constr��,:.�� possib/e abuse of the sysfam, inadequ fe mainlenence, or future water usage. �� Name: _. L1CJ� ��"��(1� --- Certification number; ,��,_ .., . , Business license name and number: Sl�+r��r1r� SQ�l�„��C� �a. ___ . .... , _ or Name of local unit ov e ^ ., . ._ . . . , . .. Signaiure: � Date: �..��. ....... _ ......... .. _. Required A tachments Inspector Complete:This Inspection Report is �page5 long. Cheek�omplianae forms attached: �ydrdullc Partortnance �'ank Integrity �Soil Separdtlon ❑Operating Perm�i F�rm�,? applicable) tem drawing/As-built dra�vinp ❑An assessmenl of any Iocal requiremBnts that are different irom whai�s reC��reo on;r�s form �So Boring Logs ❑Abandonment lotm(i/approprlate) ❑Olher inlormaUon (I�t)_ Upgrade Requirements(derived irom Minh. S�at. §•115.55)An immJnenl tArool lo public heatlh and aa/ery(ITPhIS)musi Oe upg�aaea.ie��acec :- �fs usa 0lscanlinued wilAin len+nonfh�ol nceipf of IAAs�olks oi wifhin i ahorfei pariod il iequired oy local adin�►nce.fr Ine tylfem,a/a�tmg ra pro�e:r;�o..rr Marei,I�e syalem mus10�upniad�d,nplaead,aifa yae diacanlinu�d wilhin U+e lime requirod by laea/ordinancr,!l 8n err'Sling sysiem�S nor far�,r;�s:e::r•:: •• faw,and nss af�eas!Iwo leel ol d�sipn Job�sperafiab.Ih�n Ihe syslem noed noi De upQraOed,rspairod,rcD�eeod,or ils use oiscom�nueo.norw��r:s:�:�:•::;�^, locai ordi�8nee lnal is mora suicf. TAIs Drovi�ion dasq nof spply lo ty8fems in tnore�ano areas,WalMe�rd PiOfeCUon Areas,oi rnose usea�r+:a�+r.�:r;.:: .�•�••:__ �ove�oga.ana iodginq sa�a0lisl+msnfs as ee�inad in bw. wq-wwists4•31 Compfiance Inspec�ion form far Ex�s:�•^•q SST� al1I08 50/Z0 3�JGd ZZiEEL8Z56 6Z�bT TZ0Z/99190 F�arcel number: System atatus: Compliant ❑ Noncomp��an� �� (2s determined y this Iom►) Hydraulic PerForn�ance and Other Compliance , Co�mpliance Issue #1 of 4 � Da�of observation: Reason for obsenration: ...�.,. ,_ This form expires upon next in pecGon or in three years,whichever occurs first: � _.... , ,_.____� ComplianCe questions/criteria: (Required) Verification Method': (Optional) (Check!he a ro riate box (Check the approprlate box) Does the system discharge sewage to the ❑Yes �No � Searched for su�face outlet _g„round surface? _ Perfonned hydraufic test Does the system discharge sewage to drain ❑ Yes No _tile or surf�ce waters? �Searched for seeping in yard Does the system cause sewage backup ❑Yes No ❑ Checked for backup in home inta dwellin or estabiishment? ❑ Excessive ponding in soil systemlD-boxes Do other skuadons exist�at have the . ❑ Yas No �Homeowner testimony potential to immediately�nd adversely impact or threaten public health o�safeiy ❑ E�camined for su�ging;n tank eleccrical,unsafe covers,etc. ? ❑ "Black soil"above soil dispersal system Any"yes"answerindlcates that the system is an fmminen! threat to public hea/th a»d safety. ❑ System requires•smergency'pumping _ ❑ Performed dye test �oes the system pose a ihreat to ground ❑Yes No � p�er: _.,.._ ___�___._. water for any�nditions deemed non- '—"-� rotective as deteRnined b the Ins rt "Yes"lndfeates that the system/s failing to protiect . __... .— ..... . . ground water.!f"yes'; descr/be bhe cond)tlon noi�ed: �� 'No standard profocol exists. 1"his list is not exhaus(i�e, _,,, in sequential order, nar does it indicafe which combinatioRs a�nc�cessary to make this determ;nation. Certification This form Is io be compl�tsd and atteched to the Summary Form of the Mic►nesota Pollution Contrel Agency's (MPCA)Compliance Inspection Form for E�tisting Subsurtace Sewage Treatment 5ystems. Ohservations,i�terpretatians, and conclusions must be completed by an inspec�or. Complete farm must b ubmlcted to the local unit of government wichin 15 days. Pro ert owner name(s)r V a ------. ��•- -•--��- P Y �^-- Property�ddress: � • ---------- - -- Property qi+n►n r's address(if dit�rent): County: Phone: _.__. , f hereby aertlfy that/personally made the observations, interpretations, and conclusions reported on th;s form and that they are correct. Name: ��1 � 1 V Y1� Certiflcation number: ��1 _.,... Business license name and�umber: �1�la C��UI'�O _��V�LQS �� ._.__, , . ..._. or Name of local unit f over ent: —.. Sig n ature; D ate: �_...—--...—....--•--- wq-wwists4-.31 Camplinnce Inspection Form for Exiscing SSTS 4l1/08 90/Z9 3�Jdd ZTtEEL8Z96 6Z�bt tt0Z159/50 Parcel numt�er: � System status; Compliant ❑ Noncompliant (as determined by his form) Tank Ititegrity and Safety Cotnpllance Compliance Issue #2 of 4 Date of obsarvation: Reason for observation: �i � __.__,..�._____— This form expires on(three years): _ _ Compliance questianslcriteria: (Required) Yerification Method"'`: (Opdonal) Check the a ro riate box (Check the eppropriate box) Qoes the system consist of a seepage pit•, ❑Yes o � Probed tank bottom cess ool,d ell,or leachin it? ❑ Observed low fiquid level Do any sewage tank(s)leak below their ❑Yes No desi ned o ratin de h? �Examined consvuction records If yes, idenMy which sewage �Examined empty(pumped)tank �l�-7�f� tank leaks. ❑ Probed outside tank for"black soil" Any•�es��aeswerindlcates thar the syst�em is fall/ng to protect ground water. • ❑ Pressure/vacuum check ❑ Other: _ ' Seepage pits meeting 7080.2550 may be compllant if allowed in ordinance by local pertnitting authority. — -- � •',No standarsd protoc�o►exists. This lisf is not exhaustive,in sequentia/order,nor does ft indlcate which combinarions are necessary to make fhis determfnation. Safety Check 1, Are any maintenance hole cevers damaged,cracked,n�appeared to be st�ucturally unsound7 ❑Yes' �No 2. Were alt maintenance hole covers replaced in a secured manner(e.g.,all screws replaced)? �Yes ❑No' 3. Was secondary actess r�traint presenl(safety�an,second cover,or safety netting)—highly recomrnended. ❑Yes No 4. Was any other safetylhealth issus present9 ❑ Yes" No Euplain: _�_ � _ .--- --._.. 'System Ts an Immin�ent threat�o publlc health and saiety_ Certificatiun This form is to be amplet�d and aitached ta the Summary Fo�m of the Minnesota Pollu�on Control Age�cy's(MPCA) Compliance Inspectlon Fortn for Exis�ing Subsurfsee Sew�ge Treatment Systems.Observations, interpretations,and conclusions must be completed by an inspectorj maintainsr,or se�viCe pl'ovider. Completed Mrm must be submitted lo che loca� unit of government within 15 days. Property owner name(s): � I ._—. __ ..., _.—_.__ Property address: —12`�� ' 1� .., . Property nwner's address 1if di[fsrent): ., ,--. County: ��\� Phone: �.., . ... 1 hareby cerllfy thai 1 personally made the obseru8tions, inferpretations.and cenc/usians roported on this form and fhat they are correci. Name: _.,,,,J�1 ��U� �� CerUfication number; 1�0�1 __._. .. _ Business license name and number: � tior��U�YJ �C4_.� ��.�� .. _ °� Name of local unit ove nt: .. Signature: Date: ��.� wq•wwfs[54-31 Compliance Inspection Farm for Ezistfng SSTS 411I08 50!£0 39dd ZttEEL8Z96 6Z�bt ZZ8Z/90I90 Parcel number: _._____,.__._._�_, „� System status; �Compliant ❑Noncompliant (as determined 6y tl�is form) Soil Separation Cornpiiance and Other Cort�p�ranae COmpliance issue #3 of 4 Date of observation: � Reason for observadvn: Gl (�. _„� Thfs informatior►on this form does no[expire. Compliance questivns/criteria: (Required) Verificatfon Method"""': (Optional) _w Check the ro riate box (Check the appropriate box) For systsms buflt prior to April 1, 1996, and not �Cond�cted soil observation(s)(attach boring logs) located in Shoreland or Wellhead Protection Area or not serving a food,beverage or ❑ Two previous verifications(attach boring logs) lodging establishment: ❑ Other: �� 1 �� -- l-Q 1� Does the system have at least a 1wo-foot ��.-a-TIl�'�- l��jv�.►t� vertical separa�cn distance from periodically ,��5 saturaced soil or bedrock? � Yes No /UD l�7 For non•perFormance systems builtApril 1, �� .�.,�..l.�s��4' 1996,or later or for non-performance systems �il observaGon does not expire,Previous observativns located in Shor��and or Wellhesd Protection by two independent parties are suificient, unless site Areas or servinp a food,beverage or lodging conditions have been altered. establishment; Does the system have a three-foot vertical separation distance trom periodically saturatod _sail or bedrock?�, Yes ❑ No For reduced separation distance systems(i.e., perfortnance systems under old 7080.0178 or ' �ay be reduced by up ta 15 percent if allowed in loc�! „ „ 7ype IV or V system under new 7080. 2350 or ordinance, 7080.2400): ••No standard protocof exists. This list is not exhausGve, Does the system meet the designed vertical in sequentia!order, nor does it indicate which separacion distance from periodically saturated combinatrons are necessary to make this soil or bedrock?' „ � ❑Yes No defermination. Any"no"answer indicates Lhat the system!S failing to protecf ground water. Certification � This form is to be completed and attached to the Summary Fo►m af the Minnesota Pollution Contr�l Agency's(MPCA) Compliance Inspection Fortn for Existing�SubsurFace Sewage Treatment Systems. Observations, interpretations, ana conclusions must be completed by a�inspector o�designer.Completed form must be submitted to the local unit of govemment within 15 days. F � 1 ProperCy owner name(s); _ l�l b _,. ..,. .. ------•---- �-- - Property address; ` C� _�,--�-- ----�- -•-- Propert�r owner's address(if different); ,�,. _ ••� ---• ----� ••• County; _�� Phone: .v _._.. .- -- �— 1 hereby cer7�fy fhaf!personally mede the observations, interpretations, and conclusions reported on this form and that they are c�rreck - Name; �Q�� V Certification number: � � ..,__ Business license name and numbe�, ��i '� 1 . .,,,. �5�- or Name of local unit o( ern t: _., � -�- � -- -• Signature; _ . �ate: ,�__,____ ,, ... wq-wwiscs4•31 Comp(iance Inspection Form fo�Existing SSTS 4/1/08 90fb9 39Gd ZTZEEL8Z96 6Z�bt tt9Z/50/5e 05I05/2011 14:29 9528733112 PAGE 05/65 . . .. ..... . ........... .i.. .... . .. .......... ..... ... • .....y....... ............ ... ...... ...... ... ..... ..... . ...... ... . . . , ............ . .... ... • .... ... ... ......:. . .... ....... ....... .. ..... .. ........... . . ..... ... .. 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Box 66 \�--� Orono, MN 55356 Crystal Bay� MN 55323-0066 To Current Owner: Address: ��L� I� �� -`O � � City Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every two years. The on-site sewage treatment system at the above address has been inspected and appears to fall into the categories checked below. SYST'EM CONFORMITY (1-3): I 1 "CODE SYSTEM" An ISTS which meets all the location,design and construction standards of the current Orono Municipal Code. Z "COMI'LIANT SYSTEM" An ISTS whicu does not meet all the location,design and construction standards of the cunent Orono Municipal Code but does meet the three foot separatio�requirement or two foot requirement for systems installed 1996 or eazlier,and which is not failing or an imminent threat to public health or safety. 3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-yeaz flood plain,any ISTS which may or may not meet all the location,design,or construction standards of the cuaent Orono MunicipaL Code and which is failing for any reason;and any ISTS with less thaa three feet of unsaturated soil or sand between the distribution device and the limiting soil characteristics. , TANK CONDITION(5-7): � Tank inspection indicates: 5 Pumpout not needed at this time. 6 Septic tanks must be pumped out this year (city code recommends tanlcs to be pumped out once every 3 years. Tank was last pumped 1• Make sure se�tic tanks are uumaed throush manhole and not throuQh white inspection aipes. This allows for the proaer cleanine Keep water softner and iron filter discharse out of seatic svstem to prolonQ life of drainfield. Ask aumaer to test alarm float to verifv alarm iS still workins in vour house The alarm warns owner that seataee is about to backua into basement. 7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tanic. If tanks have not been pumped out within the last three years,they should be pumped out now. DR.AINFIELD CONDITION(8-10): � 8 Drainfield is dry,no surfacing evident. 9 Some evidence of surfacing,not critical yet. 10 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector immedi$tely.Repairs must be completed within 90 days. COMMENTS: � G� -,�a -t�� Date of Inspection Septic System Inspector - - . ,. ., . � � -- �- -�----�.�_..t:- ----- �--- �� O �.. O ��:��_��;� CITY of ORONO �a , �,ra�� :.�. . � �;- �' � Nt�ntcipat offices � �'"��► G ' �F��1 Street Addrass: Mailing A�reas: �'�'y�Hp�'� 2750 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal Bay, A�I 55323-0066 entOwner: Address: �6�d �� '`� T� Curr City Ordinan�ce 199 requires that each existing on-site sewage treatment system in Orono be inspected every two years. T'he on-site sewage treatment system at the above address has been inspected and appears to fall into the categories checked below. TE CONFORMITY (1-3): � 1 "CODE SYSTEM"An ISTS which meets all the location,desi�and construction standards of the current Orono Municipal Code. "C4MPLLANT SYSTEM" An ISTS which dces not mcet all the location,design and constntction standards of the curnnt Orono Municipal Code but dces mat the @uee foot separstion requirement or two foot requirement for systems instalied 1996 or earlier,end which is not failing or an imminent threat to public health or safety. 3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS locabed within a designated 100-year 800d plain,any ISTS which may or may not meet all the locstion,design,or construction stsndards of the current Orono Municipal Code a�which is failing for sny roason;and any 1STS with less then three feet of unsaturated soil or sand between the distribution device and the limidng soil characteristics. TANK CONDITTON(3-71: �T inspection indicates: Pumpout not needed at this time. 6 Septic tanks must be pumped out this year (city code requires tanks to be pumped out once every 3 years. Tank was last pumped 10�2-03 ), Make sure septic t�aks are pumped throu¢h manhole and not through white insnection pipes. This allows for the prouer deaning. Keep water softner and iron filter discharge out of septic system. 7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank. If tanks have not been pumped out within the last three years,they should be pumped out now. D INFIELD COND fTION 8-10 : 8 Drainfield is dry,no surfacing evident. Some evidence af surfacing,not critical yet. 10 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector immediately.Repairs must be completed within 90 days. co�rrrs: ��,.� �� s c��;� .�-•v,.lcs � oo)L oK _ q-t�-�� Date of Inspection Matt Boltaman- Septic System Inspector Notc: In the erart that this iaspaxion report is used to satisfy tl�e requirert�ents for a mortgage or odnr transfer of property,be advised tfiat this report does�t guarantee or certify ti�et m existing systcm will contin�to fundion properly,but is nurely an opinion ofttre adequacy of tlie system under cunent�nditio�s based on the available informati�. 1i�ephone(952)Z49-4G00 • F�c(�'S2)249-4616 �►ww.ci.orono.mn.� . . . µ�,."� y "�,y,F:::�.�..., M, ��f( . . � ��'.e�+k,T��i...'. . . _:<+►,..•,y{. . a � .� � .. . � � �. . . - . . � Compliance Inspectio� �orm for Existing � Individual Sewage Treatment Systems _ -�.�,�;�a�� «� , .... This form reflects the requirements of the 1996 version of MN Rules Chapter 7080 � �,,,,� . ., .k^.71� Minnesota Pollution Control Agency Note:Local inspection standards may be more or less restrictive than the state requirements. These differences must be made available by the Local Unit of Government. Date of Inspection: ,�`�� - -=� —r. ! , .. Property Owner(s) ��;��C. :'� lr`-,rf4 Jfi tJ.�'.✓:��'� Telephone�':� �i��GD- �S��- Person requesting inspection(if different than owner) Telephone( ) Reason for inspection: Site Address .�� f{C� ,.� � ;� ��' �- -r City C' �%c:n..; �- Zip Code Unit o�'Government Regulating this property Fire No. Parcel No. Township Name Township Range Section Quarter (Check appropriate sewer system component and indicate location on site sketch). ank s : Soil Treatment System: Other�briefly describe�: Flow Meter �Septic tank Rock trench _Alternative system _Aerobic tank _Gravelless pipe trench _Experimental system Yes �'��No 1 Pump tank Chamber trench _Warrantied system If yes, ``� Holding tank Seepage bed Exp.Date: _Other ,�Mound _ Other _At-grade Svstem Classification System Built Prior to April l, 1996 and not Located in Any System located in Shoreland or Wellhead Shoreland or Wellhead Protection Area or Serving a Protection Area or Serving a Food, Beverage or Food, Beverage or Lodging Establishment Lodging Establishment, plus all systems Built after April 1, 1996 Is the system an imminent public health threa�(IPHT)?U�grade Is the system an IPHT? Upgrade 1.Discharge of sewage to the ground surface? '' YES -'NO ]0 mo 1.Discharge of sewage to the ground surface? YES NO 10 mo 2.Discharge of sewage to draintile � - 2.Discharge of sewage to draintile or or surface waters? YES 10 mo surface waters? YES NO 10 mo 3. Sewage backup into dwelling? YES � 10 mo 3.Sewage backup into dwelling? YES NO 10 mo 4.Situation with the potential to immediately and 4.Situation with the potential immediately and adversely impact or threaten public health or adversely impact or threaten public health or safety? YESj�O� , ' 10 mo safety? YES NO ?0 mo � `�'"� Is the s stem failin � Is the svstem failing. Y g• 5.Less than TWO feet of vertical separation between 5.Less than THREE feet of vertical separation between system bottom and saturated soil or bedrock? YES�? LGU** system bottom and saturated soil or bedrock? YES NO LGU** 6.A seepage pit,cesspool,drywell,or leaching pit? YES r N(�,' LGU** 6.A seepage pit, cesspool,drywell,or leaching pit?YES NO LGU** **LGU=Local Unit of Government ordinance must specify the time period within which the system must be upgraded. STATUS OF THE SYSTEM Based on the compliance criteria above the system status is (check or�e) in compliance(functioning)0 failing�n imminent threat therefore,this document is a(check one)0 Certificate of Compliance,�Notice of Noncompliance. t � Page 1 of 2 {; <i , : ; , ' �` � � �� ,� r } � 1 � � ` � t' A � � '!I _. Site Sketch: . . �,��`�;,�'.� .. . . . ... . •f�t��`. .. . i: .. .. � .. .'. . :`"'.. . .. . .. . .. . .._.:�,.,,,. .. � . .. � #� .. .. . , . . . . ' . . .. . .. ' . ": .�• . . � . .! '. .. . . . ' . . .. . .. . .. . .. . .. :�,. ..:�--�-;;:� : . , .. .... . .. . .. . .. . .. . .. �.. ".i. . ;�;... ....... .. . .. .. . .. .. .. . .. . .. . .,.�!'._� . .. . .. . . ...; . , . ,•: ,l.��.� . . �`. f . . �r�1 - - • . .. +'�i '�. . . . . . .',�r�,;. . . �. . . . . .. , .. . IOU' �` .. . . ��.. .. . .. . .. . .. � 10' 2�' � _.:. . .. ..'�:... ,. ' .. .. .. � . .. . . � N � . . .. . .. . .. . .. . .. ; . .. �x%�u � � .. . . . .. . .. .. .. . .. . .. .. p � Plense iudicatc the location of: Wcll,�vell setback to sySlem,dwelling or othe.r eat�blishmcnt,tank(S).Spi1 trea�icnt syste.m, r�served soil tretl4mcnt arc3,ciutain draiii,properl)'lincs,�vatcrwa}'s,and buried lines (thosc NO7 instalIed by thc utilitt�). Include�.ize��ulcl length rind approximate distances from fi�td refcrcncc points such As strcrts and buildinfis, pleasr attach as- built dra�cings,inspzction reporYs,CCrtificat(s}of Compliance nnd Noticc(sj ofNonci�mplianrc,if�h•silabl�. Soil Bu,•ings (BR#): Loeate; each roring oz�the iiiap above, indicate on the ribht o£t��.e coluinn the soil texture, struct��re, color, dept�x of each different soil tylae, evidence uf mottling, bedrock�nd st�u�ding w•atcr. Also iz�dicate if the material is fi1L BR� }3R# BR# BR# BR#� BR# <:; ','f 'Y � :`� , �,�,..� � W:CORI�DEPTH OF t-IuTTLING,SE�ISUNAL IT?C��wATk,R OR BEDROCKQh ABO��E LINI.S Cnmment�: .Gf1�,��5'-.�L r„ ,,-' ` 4r 'ti _— .�'�a✓�� - '1� � ��— – �1'hat n�eds to be cpmlileted ti�briiiE,the above system into a�cnpli�ncc if found not iq compiianc ? �.,"�, . -�• j ,� � :.�,-:/rir.e_ �i l �_ i ,�, . � � � � 41� t.Jt .��G=��C' G��'r". e ��.�>� � �� ' � � r,� � i � .I �� 1 I �. � . .. _.W�_�_ ._ �_ . �� ._� ..�� . � . . � : :.� � .e:�.. ,�. d...,i��.:. �t�.vt��.� ..1,.� . 1 h,. ,.eLu__e-. i . _:Y ':�,� ..r:�r.- .... . ,�,�`..�"�wa...—�-.e--— 'eeilew.`...w.��.�:n�{a�Y"f1AR1�:�'OT�'o"_�n +a... �.r'+�'t�,An '%Ri � ' MR �AlnY[.R:t M��.�'�. . 'C I . . � .4�Ck, ��..�R-�L•�iGN�Sy . • What methods were used to make the determinations for the compliance inspection? ,�'�r *C)�"` --- "" ��:.�f . � Please attach the followin¢: 1) Site sketch. Suggested items for drawing include:Well,well setback to system,dwelling or other establishment,tank(s),soil treatment system, reserved soil treatment azea,curtain drain,property lines,waterways,and buried lines(those NOT installed by the utility). Include sizes and length and approximate distances from fixed reference points such as streets and buildings. 2) Soil boring logs,showing each horizon. Indicate the texture,structure,color,depth of each different soil type,evidence of mottling,bedrock and standing water and whether the material is fill. Locate each boring on attached site sketch. 3) A list of any and all requirements of the local ordina�ce that aze different than the sate requirements referred to on this form. CERTIFICATION A. I hereby certify that all the information I have provided regarding the individual sewage treatment system is true,accurate,and complete. Property Owner Date B. I hereby certify as a state of Minnesota licensed Inspector and/or Designer I or Qualified Employee Inspector and/or Qualified Employee Designer I that I conducted an investigation in accordance with applicable requirements that accurately determined the compliance status of this system and that my observations recorded aze accurate as of this date. No determination of future hydraulic performance has been nor can be made due to unknown conditions during system construction,abuse of the system,inadequate maintenance,or future water usage. ,,;, ;�. ! '�: Inspector's name(print) ...j,�:� �:;;�,;�"cl�'<i.e. G/ Phone ��-..��-�`—K,:��,,<�,c-- �:;. . —� �' r . License and/or Registration Number � Address ��,�,` �"_'�} •�'77 �t a��._. ,r':.� � �. .-; s^ / . Employed by i�l,c.�;�e��t,/+�..ed �� Address ��.;:,i�,»�^`., Valid until ,unless the system becomes an imminent threat to public health or safety as defined at Minn.R.7080.0020,subp. 19a,before that time. � Signature � Date " "'ti ' �` % Uparade Criteria � Minnesota Statutes § 115.55 ("law") Upgrade Requirements Any situation with the potenfia!to immediately and adversely affect or threaten public health or safety, must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a sho►ter period of time if required by local ordinance. If the local unit of govemment with jurisdiction over the system has adopted an ordinance containing altemative local standards, the existing system musf comply with the ordinance. If the system does not comply with the ordinance, it must be upgraded, replaced, or its use discontinued according to the ordinance. If a seepage pit, drywell, cesspool, or leaching pit exists and the local unit of govemment with jurisdiction over the system has not adopted local standards to the contrary, fhe system is failing and must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If the system fails to provide su�cient groundwater protection, then the local unit of govemment or its agenf shall order that the system be upgraded, replaced, or its use discontinued within the time required by rule or the local ordinance. If an existing system is not failing as defined in law, and has at least hvo feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any Iocal ordinance that is more strict. This does not apply to systems in shoreland areas, wellhead protection areas, or those used in connection with food, beverage, and lodging estab/ishments as defined in law. p:\ists\prog_dev\exinp9.doc-6/99 Page 2 of 2 " ,.,�� I �„ I l` ; , .�;. CITY OF ORONO � O� Municipal Offices O O Post Office Box 66 Crystal Bay, MN 55323-0066 � � ON—SITE SEWAGE TREATMENT r�,�` �, INSPECTION REPORT '�� G~ 9kESHo4� .�� ' , Owner: ��i'! � (/1l _�M`t/��C Address: �(i/(/ �a�✓IP ,, �.��/ Permit �'s: �� Dates:_ �'"o��'��-/ Contractors: � �:4�� City ordi.nance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis. The on-site sewage treatment system at the above address has been inspected and appears to fall into the category checked belou. (This is� an existing system [ 7 neu construction> � ` STEM CONFORMITY 1-3 : t �'CODE SYS7EM"-A system wh9ch meets all the location, design, and construction standards of the current City Codes, and uhich is operating satisfactorily by treating and disposing of the entire current seWage input without discharging any pollutants into ground or surface waters. 2 "CONFORMING SYSTEM"-A system uhich does not meet all the location, design, and construction standards of the current City Codes, but Was installed according to the code in effect at the time of installation, and which is operating satisfactorily by treating and disposing of the entire current sewage input without discharging any pollutants into ground or surface Waters. 3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any system which may or may not meet all the tocation, design, and construction standards of the current City Codes and which is failing for any reason; and any system uith less than 3 feet of unsaturated soil or sand between the distribution device and the limiting soil characteristics. (The limiting soil characteristic �has or [ ] has not been identified at this time. If the limiting soil characteristic has not been ident�'fiecT' this classification may be subject to revision.) TANK CONDITION (5-10): Tank inspection indicates: Pur�pout not needed at this time. Sol�ds accumulation in tanks indicates they should be pumped out this year to help prevent future problems. Solids accumulation in tanks is at a critical level. Tanks should be pumped out as soon as possible. 8 System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface dischar�e. 9 ]nspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each tank at next punpout. If tanks have not been purnped out within the last three years, they should be pumped out now. 10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation). !f tanks have not been punped out within the last three years, they should be pumped out now. DRAINFIELD CONDITION (11-14): � ield inspection indicates: 11 rainfield is dry, no surfacing evident. Some evidence of surfacing, not critical yet. 13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector irtmediatety. Repairs must be completed within 90 days. 14 Drainfield extent and condition unknown. LIMITiNG SITE FACTORS (slope,setbacks,etc.): — POTENTIAL FOR SYSTEM FAILURE (depends on soils,uater table,etc.): COMMENTS: s � -- � Date of Ins ection Septic System Inspector Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property, be advised that this report does not guarantee or certify that an existing system uill continue to function properly� but is merely an opinion of the adequacy of the system under current conditions based on the available information. This report must be kept on the pre�nises with the system locatien and pumping records. WHI7E COPY/Inspectors File YELLOW COPY/Homeowner I CITY�OF ORONO � � �� Municfipal Offices O O Post Office Box 66 Crystal Bay, MN 55323-0066 � � ON—SITE SEWA(�E TREATM81�1'1' ,� � INSPECTION REPORT ti ! ��9k'ESH.�g'�G r � /� Owner:� )'1 � Address• � Permit #'e: �'l7 Dates:��b� Contractors: City ordinande number 100;requires that each on-site sewage treatment system in Orono be inspected on a regular basis. The on-site sewage treat�ent system at the above address has been inspected and appears to fall into the category checked beloN. (This is � an existing system [ ) new construction) SYSTEM CONfO ITY 1-3 : 1 "COD� SYSTEM"-A system which meets all the Location, design, and construction standards of the current City (�odes, and whi�ch is operating satisfactorily by treating and disposing of the entire current sewage input ithout discharging any pollutants dnto ground or surface waters. 2 "CON�ORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the rrent City Codes, but was installed according to the code in effect at the time of installation, and which s operating satisfactority by treating and disposing of the entire current sewage input without discharging y pollutants into ground or surface Waters. 3 "NON C�IFORMING SYSTEM"-A prohibited 'system; a system located within a designated 100-year floodplain; any stem which nay or may not meet pll the location, design, and construction standards of the current City �des and whiah is failing tor any reason; and any.system with less than 3 teet of unsaturated soil or sand qetween the d�stribution device and the limiting soil characteristics. �The limiting soil characteristic �j�1 has or [ ] has not been identified at this time. If the limiting soil haracteristic has not been identifiied, this classification may be subject to revision.> TANK CONDITIr 5-10 : � yanJc inspect`ion indicates: (_j� Purtipou� not needed mt this time. 6 Solids eccumulation in tanks indicates they should be rxmped out this year to help prevent future problems. 7 Solidsfaccunulation in tanks is at a critical level. Tanks should be punped out as soon as possible. 8 Systembis discharging to the surface. Tanks must be punped out within 48 hours to eliminate surface dischar�e. 9 Inspec�ion risers missing-tanks could not be inspected. lnspection risers (4" dia. pipe) �st be installed in each lank at next pumpout. [f tanks have not been pumped out within the last three years, they should be punped but now. 10 Inspedtion pipe is located directly over tank baffle (does not give accurate measurement of solids accunulation). If tanks have not been punped out rithin the last three years, they should be pumped out now. DRAI FIELD DIT10N 11-14 : D�field nspection indicetes: 1 Drain eld is dry, no surfacing evident. Sane idence of surfacing, not critical yet. 13 Drain ield is saturated and visibly di�charging untreated etfluent to the surface. Contact the City [nspector �mmediately. Repairs must be comp eted within 90 days. 14 DrainfEield extent and condition unknown. LIM1 ING SI E FACTORS s o setbacks etc. : POTENTIAL F�R SYSTEM FAiI�URE (depends on soils,water table,etc.): L�/ h COM�IENTS� Date of Inspection tic System inspector Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property, advised that this report does not guarantee or certify that an existing system will continue to function properlyi t is merely an opinion of the adequacy of the system under current conditions based on the availabte i nf armat i or�. ' This report must be kept on the premises with the system locetion and punping records. ; WHITE COPY/Inspectors Flle YELLOW COPY/Homeowner [ � CITX OF ORONO �O� Mu�icipal Offices O O Post Oftice Box 66 Crystal 8ay, MN 55323-0066 � � ON—SITE SEWA(3E TREATI�NT v�, �, INSPECTION REPORT ti ��9kE5H��G Owner:T/�/Q�_ �/!///1 Address• , Permit �'s: Dates: tS��o��C� Contractors: Ul.�l'1 !��!'�/v�� ! City ordinarlce number 10� requires that each on-site sewage treatment system in Orono be inspected on a regular basis. The on-site sewage treatment system at the above address has been inspected and appears to fall into the category checked below. (This is ,� an existing system [ 7 new construction) SYST M CONF MITY 1-3 : 1 "CODE SYSTEM"-A system which meets all the location, design, and construction standards of the current City Codes, and which is operating satisfactorily by treating and disposing of the entire current sewage input without discharging any pollutants into ground or surface waters. 2 "CONFORMING SYSTEM��-A system uhich does not meet all the location, design, and construction standards of the current City Codes, but was installed according to the code in effect at the time of installation, and which is operating satisfactorily by treating and disposing of the entire current sewage input without discharging any pollutants into ground or surface waters. 3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any system which may or may not meet all the location, design, and construction standards of the current City Codes and which is failing for any reason; and any.system with less than 3 feet of unsaturated soil or sand Ibetween the distribution device and the limiting soil characteristics. (The limiting soil characteristic p� has or [ ] has not been identified at this time. If the limiting soil Characteristic has not been identi'fied, this classification may be subject to revision.) TANK CONDITION (5-10): Tank inspection indicates: ,5�, Pumpout not needed at this time. (6> Solids accunulation in tanks indicates they should be pumped out this year to help prevent future problems. T Solids accumulation in tanks is at a critical level. Tanks should be punped out as soon as possible. 8 System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface dischar�e. 9 Inspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each tank at next punpout. If tanks have not been punped out within the last three years, they should be punped aut now. 10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accunulation). If tanks have not been punped out within the last three years, they should be punped out now. DRAINFIELD CQNDITION C11-14): field inspection indicates: 1 Oraintield is dry, no surfacing evident. 2 Some evidence of surfacing, not critical yet. 13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector iRmediately. Repairs must be ca�leted within 90 days. 14 Drainfilld extent and condition unknown. LIMITING S1TE�fACTORS Csloce.setbacks,etc.): ,� POTENTIAL FORiSYSTEM fAILURE (depends on soils.�ater table,etc.): COMMENTS: Date of Inspection e ic System Inspector Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property, be sdvised that this report does not,guarantee or certify that an existing system will continue to function properlyi but is merely an opinion of the ad�quacy of the system under current conditions based on the available information. This report must be kept on th� premises With the system locetion and pumping records. WHITE COPY/Inspectors Ffle YELLOW COPY/Homeowner � On the North Shore of Lake Minnetonka ON-SITE EWAGE T EATMENT IN ECTION R PORT � POST OFFICE BOX 66 1335 S. Brown Rd. � �I � � � � Crystal Bay, MN 55323 � 473-7357 � � �' f� D/ OWNER � ��e i�h'1�� ADDRESS _s��Q /��eY /�' PERMIT N�.'S. �� DATES �«�/ CONTRACTORS w��'• City OFdinance No.21U requires that each on-site sewage treatment syatem in Orono be inspected on a regular basis.The onsite sewage treatment system at the above'address haa been inspected and appears to fall into the category checked below. i , (This is �an existing system ❑ new construction) � ' Meets or exceeds current City standards in all respects relating to deaign,construction,end location.Appears to be operating prOperly. � 3 Does not me�at all current City standards for new construction (1978 Code) but in most respects appears to be designed, located, and�onstructed generally in accordance with previous codes.System appears to be functioning properly;no major upgrading of the system is required at this time. � � Does not meet current City standards in many respects relating to design,construction,or location.Appears to be operating , adequately at this time,but has a relatively high potential for future problems. No major upgrading of system is required at this time. � � System may ar may not meet current City standards for design,construction or location, but is faili�g to properly treat and � dispose of the current input,and is endangering a water supply,or is a source of pollution to surface or groundwaters,or is p creating a safety hazard,or is otherwise creating a public nuisance.Please contact the City Inspector to discuss system repair/ � replacement qrocedures. If drainfield replacement is neceuary,wil teating will usually be required,and a desig�and site plan � must be submitted for review.Your contractor must obtai�a permit before work is started. SYST M CON ITION (m Chiecked items may�equire your action) Tan mspectio indicates: ❑ Inapection pipe is located directly over tank baffle.(Dces not ,�,Pumpou not needed at this time. ; give accurate measurement of solids accumulation.) If tanks ❑'Solids umulation in tpnks indicates they should be pump- have not been pumped out within the laat three years,they ed out is year to help prevent future problema. � should be pumped out now. ❑ Solids umulation in tanks is at a critical le�yel. Tanks Drai ield inspection indicetes: should�pumped out aa'aoon as possible. �Orainfield is dry,no surfacing evident. ❑ System discharging t0 surface. Tanks must be pumped ❑ Some evidence of surfacing,not critical yet. within houra to elimirmte surface discharge, ❑ Drainfield is saturated and visibly discharging untreated ❑ Inspecti risers missing—tanks could not be inapected, effluent to the surfece. Thia condition may require replace- Inspectidh risers (4"dia.pipe)must be installed in each tank ment or additions to drainfield. Contact the City Inspector et next�mpout. If tanlas have not been pumped out within immediately.Repairs must be completed within 90 days. the laat r ree years,they Ehould be pumped out now. ❑ Drainfield extent and condition unknown. SITE C ARAC ERISTICS Limiting Site Fa�tors Potential for System Failure Site Capabilities for ❑ Slope � (depends on soil typea,water Future Expansion ❑ 3oil table and system condition) �'Adequate �Migh wat�r table �Low O Fair ❑ Lot size �. ❑Medium O Poor ❑ Lake,wet�and,or stream ❑ High ❑ Inadequate ❑ Drainage � ❑System is causing visible surface discharge. i COMMENTS: �i � �-�3 9/ � Date of Inspection eptic System Inspector k Note: In the eve that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that this repo�rt does t guarantee or certify that an existing system will continue to function properly,but is merely an opinion of the adequacy of the system un r current co�ditio�s based on the available information. � This report must be kept on th@ premises with system location and pumping records. If WHITE COPY/tnspector's File GOLD COPY/Homeowner P f E � 4