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Home My WebLink Aboutseptic info SEPTIC SYSTEM INVENTORY Site Address: 1980 Sixth Ave N PID 27-118-23-42-0004 Owner Name: Neel Kashkari Owner Address: 1980 Sixth Ave N Long Lake MN 55356- BuildingTvpe: residence Installer: Hayes Exc., ingleside Date of Permit: 11/02/10 System Type: mound BR's Designed for 4 In Musa?: No Shoreland?: SEPTIC TANKS: Material: precast concrete Capacity: 1000,1000,1000 Tank Filter: DRAINFIELD: Treatment Area: 83*40 Soil Boring: yes DF Ht above Wt: 3 WELL DATA Setbacks -Well Tanks: 120 Well DF: 140 Report In File: Depth: 151 INSPECTION RECORDS PUMPOUT RECORDS Date Notes Date GallonsOfLiquid 11/1/2010 mound added onto 1 bedroom 11/12/2018 1000 9/1/2006 Okay 11/10/2015 2500 10/12/2004 Okay 9/4/2012 2500 10/8/2002 no surfacing,pump tanks 11/1/2010 0 9/5/2000 no surfacing 9/15/2008 5/12/2000 final ok 7/19/2005 3000 1/6/2000 no surfacing 7/19/2005 3000 10/18/1999 replacement installation 10/18/1999 replacement installation - .__-__-: _ �"� � � � /i�o `. (� o '�`� �, '�'; CITY of UltONO ��. � : �;: ': , �G,, : Municipal Offices `,„�, i. ' ti , � '� � -'� G Street Address: Mailing Address: �9kEs�p4�� 2750 Kelley Parkway P.O. Boz 66 ._. - Orono, MN 55356 Crystal Bay, MN 55323-0066 To: The Current Owner of Address r� �� ' �� City Ordinance requires that onsite sewage treatment systems in Orono be inspected on a periodic basis. The onsite sewage treatment system at the above address has been inspected and the following is known about the system. A sketch of the known components of the system is available for most properties at the Orono City Hall. Imminent Public Health Threat Yes �No If yes, please contact the Onsite Systems Manager at 952-249-4626 within 10 days of recei�t of this notice. The septic system must be brought into compliance within 90 days. Failure to do so will result in referral to the City Attorney for legal action. System Identified as Non-Compliant Yes No � If yes, system must be brought into compliance by: December 31, 2007 December 31, 2010 Other Septic Tank(s) Pump out Needed Yes �No The City recoinmends the septic tanlc(s) and/or lift tanl:be serviced and pumped out every three years. City records indicate the tank(s) were last pumped out on � — l�� . The tank(s) should be cleaned through the manhole and not through the inspection pipes, this allows for proper cleaning. Gomments: �... ,;�7' ' m. Inspe�tdi��'�'��' '� �.,� Date of Inspection � '� � '�'elen�one (��2)249-�60(� � �aa (9�2) 2�9-�6��, w�w�ar.ci.o�ono.ma�.us , �� _ _._ ._ O =:, O -�� CITY o� ORONO r'� '��'� - A+ \'�,� ,' �r� � ,� MunicipalOffices �.'�;'�� ,, �"�,G Stroet Addreu: �ISa-�49-'�160 o Maili�a Addrou: ygg0�" 2150 ItElley Parkway P.p. � � Orono, MN 55356 C�rstai �, �N+I 55323-0066 � /� � To Current Owner: Address: �� `�'X�'� t'N t, N� City Ordinance 199 requires that each existing on-site sewage trea�e,�t system in Orono be inspected every two yeazs. The on-site sewage treat�nent system at the above address has been inspected and appears to fall into the categories checked below. SYSTEM CONFORMII'Y (1-31: 1 — - . _._ 1 "CODE SYSTEM"An LST$which meets all the location,design and construdion stan�rds of the cuireut Orono M�nicipel Code. 2 "COMPLIAN'I'SYSTEM" An LSTS which does not med all the location,design and conshnc�i�standards of the c�rnxit Orono Municipal Code but does meet We three foot separation require�t or two�oot require�t f�systems installed 1996 or earlier,and which is not�iling a�an�in�t threa#to public health or sa�ety 3 "NON-COMPLIANT SYSTEM" A�rsTs;�LSTs locatea within a ac.signated loo-year 800a plain,any LSTs ww�ich may or may not moet all We location,desigq�conshuction standards of the curr�t Urono Manicipal Code and wluch is�7ing�or any mason;and any LSTS with lcss than three fcet of unsa4uated so�7 or sand betvveen d►e distri'bution device and ihe limitmg so�1 charactaistics. TANK CONDTTION(5-'n: Tank inspedion indicates: 5 Pumpout not needed at this time. 6 �S�tic tanks must be pumped out tlus year (city code recommends#anks to be pumpad out once every 3 ye�ars. Tank was tast pum�ed 7_ 1. 11�Ske sare sentie ta�ks ue saetoed thren¢h�n�ole aad■ot t�rough white iasnectioa nices. T�is allows for t�e nrouer cleaaiae. Keea�va4er so�and iron�Iter disc�ar�e oat of�svstem to�rolo�life ef draiafield. Ask numaer to t�t a1'rm floxt te verifv sbre��sWl worlciag i�voer�oase. T6e ularm�vares orraer that sentage is about to backua iato basement 7 Inspection risers missing-tanks could not be inspected. Inspedion dsers(4"dia.pipe)must be installed in each tank. ff tanks have not been pumped out within ti�e last three years,they should be pumped out now. DRAINFIELD CONDTTION 8-10 : � -. 8 Drainfield is dry,no surfacing evident Some evidence of surfacing,not critical yet 10 Drainfield is sahu�ated and visibly discharging untreated effluent to the surface. Contact the City�nspector immediately.Repairs must be completed within 90 days. co��rrs: d,��-� �o c.S oK- Pv�. :st �� „�c� b c��t. ��!�r' � «C N� C� S Y� 1r�S t V?'��.. a tS l �� -��--D'� �� ,.e� nate of Iospachon Mau�olierman- septio syste�n In�Ctor Note: In the eveat ti�at this inspaxion re.port is used to satisfy We requir�ts for a m�tgage or other transfer of P�P�Y,be advised fhat this report does not guarautoe�oatify th�au existing syst�w7f eontinne w fimc�ion�lY, but is ma�elY an opinion of�e adeqnsey of the system und�cwrnst conditions based on the ava9lable information. SEPTIC SYSTEM INVENTORY Site Address: 1980 Sixth Ave N PID 27-118-23-42-0004 Owner Name: Judy&Jim Pierpont Owner Address: 1980 Sixth Ave N Long Lake MN 55356- BuildingTvpe: residence Installer: Hayes Exc., ingleside Date of Permit: 11/02/10 System Type: mound BR's Designed for 4 In Musa?: No Shoreland?: SEPTIC TANKS: Material: precast concrete Capacity: 1000,1000,1000 Tank Filter: DRAINFIELD: Treatment Area: 83*40 Soil Boring: yes DF Ht above Wt: 3 WELL DATA Setbacks -Well Tanks: 120 Well DF: 140 Report In File: Depth: 151 INSPECTION RECORDS PUMPOUT RECORDS Date Notes Date GallonsOfLiquid 11/1/2010 mound added onto 1 bedroom 11/10/2015 2500 9/1/2006 Okay 9/4/2012 2500''. 10/12/2004 Okay 11/1/2010 0 10/8/2002 no surfacing,pump tanks 9/15/2008 9/5/2000 no surfacing 7/19/2005 3000 5/12/2000 final ok 1/6/2000 no surfacing 10/18/1999 replacement installation .� o,�,.. . O��a� . "��°s��.�, CITY of �RONO .� �ij � '-'� s+► � ,,. `�►� �1';p,�:��'�� G,ti,ti biunlcipaI o�ces • I '� Z ��%;};�;;�g,�i ' Street liddress: Mailing Address; �H 2150 Kelley Paticr�ay P.O. Box 66 � Orano, MN 55356 Crystai Bay, MN 55323•OOEb . `t5a-�49-4600 � To Current Owner: Address: �9 g� S� X�� A�e N- Ciry Ordinance 199 requires that each existin�on-site sewage treatment system in Orono be inspected every two years. The on-site sewa�e treatment system at the above address has been inspected and appeazs to fall into the categories checked below. SYSTEM CONFORMITY (I-31: ( lO"CODE SYSTEM"M IS'CS which meets all the lacation,design and construction standards of the current Orono hiuntcipal Code. 2 "CO�LIANT SYSTEM" An ISTS which daa not meet all the location,daign and construction standards of the current Orono l�funicipaI Code but does�tneet the three foot separation tequirement or two faot requiremcnt for rysucru installed 1996 or earlier,and which is not failing or 'an immi�ent threat to pubtic health or safety. 3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a daionated l00-year flaod plain,any ISTS which may or may not meet all the location,duion,or eanstrucdan standards of�e cumnt Orono Municipal Code and which is failing for any teason;and any ISTS with less than three feet of unsaturated sol or sand between the dis�ibution device and the limitino soil characteristiu. TANK CO,`1DITION(K:71: S �� T inspection indicates: � . 5 Pumpout not needed at this time. Septic tanks must be.pumped out this year (city code requires tanks to be pumped out once every 3 years. Tank was last pumped ). ' 1�Iake sure septic tanks are oumned th�ouoh manhole and not through white insaection pipes. This allo�ti•s for the proaer cleantne. 7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank. RAINFIELD CONDITION -!Q : $ 8 Drainfield is dry,no surfacing evident. 9 Some evidence of surfacing�not critical yet. � . � 10 Dninfield is saturated and visibly dischazgina untreated effluent to the surface. Contact the Ciry Inspector immediately.Repairs must be completed within 90 days. COI�LI�iENTS: rne�� 1 ��dkS o�, ��M� S e�f:� }�,n►;s neX�- S��r+�e('� Re4��cL c �P b�,. ;�SQc�r: c�. D :i�e �.n SeP�-.-< t��k_ lo - $ - ��- ��C Date of Inspecdon Matt Boitercnan• Sepac System Inspector Note:In the event that this inspection rcport is iued to satisty the requiremcnes for a mortgage oc other transfer of properry.be advised that this rcFoR daes not guz^s.�� or certify thu an existing system will continae W function properly,but is merely an opinion ofthe adequary olthe system emdcr eumnt conditIoat based on the avulabi inComution. �o r � � ;�'O O i; ,, :j� -� � CITY of ORONO �`� ,� , ti M�� o�t�� \;.'�, ,� ;�.�" T I, 'ti _�,+�_� G \, � ;, :. � � Street Addross: Mailina Addreas: ��,+gH04' 2750 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal Bay, MN 55323•0066 September 6, 2000 Dan A. Bergeron 1980 Sixth Avenue North Long Lake, NIN 55356 Dear NIr. Bergeron: An inspection of your septic system was conducted on September 5, 2000. A summary of the inspection is below. Septic Tank Condition 1. Pumpout not needed at this time. The septic system is a compliant system, meanin� it meets all or most current City and State Standards. Enclosed is a list of licensed contractors who work in Orono on a regular basis. This list is enclosed simply for your reference in case your septic system needs maintenance in the future. Also enclosed is a fact sheet explaining your septic system and how it functions. Finally, an as-built drawing is enclosed showing the approximate location of the septic system. If you have any questions regarding this report, please contact me at the City Of£ices at 249-4600. Re pectfully, i� , �� is Pence On-Site Systems Manager Enclosures In the event this inspection report is used to satisfy the requirements for a mortgage or other transfer of property, be ad�ised that this report does no guarantee or certify the e�cistinb system will continue to function properl�,but is merely an opinion of the adequac�of the s�stem under current conditions based on the av:ulable information. This report must be kept on the premises with the s�stem location and pumping records. Telephone(952)249-4600 • Fax(952)249-4616 www ci.orono.mn.us ;�� °� ,i�o 0 � �� CITY of ORONO Y . � 1�1 ��1� .t � . �, v�, �' ,,� .>° � F �lS� Municipal Offices � �. ;�: , �. \ '� i ' � �.� i�� e"�'�G SVeet Address: Mailing Addross: ,,�,,. . 9$EggOg' 2750 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal Bay, MN 55323•0066 r Owner: P �� Address: 1980 Sixth Ave. N. Permit #'s: 6086 Dates: 8/27/80 Contractors: Hayes Exc. (This is x ] an existing system ( ] new construction) . SYSTEM COMPLIANCE (1-3) : 3 1 Code System: Meets or exceeds current City standards in all respects relating to design, construction, and location. Appears to be operating properly. 2 Compliant System: Does not meet all current City standards for new construction, but in most respects appears to be designed, located, and constructed in accordance with previous �� codes and is functioning properly. i 39 Non-Compliant System: System may or may not meet current City standards for design, L� construction, or location, but is failing to properly treat and dispose of the current input; and any system with less than three feet of vertical separation ,between the bottom of the drainfield and the saturated soil level. (The saturated soil level is [�] or is not [ ] identified under this septic system. If the saturated soil level is not identsfied, this classification is subject to revision.) TANK CONDITION (5-9) : 9 5 Pumpout not needed at this time. 6 Solids accumulation in tanks indicates they should be pumped out this year. 7 System is discharging to the surface. Tanks must be pumped out within 48 hours. 8 Inspection risers missing-tanks could not be inspected. If tanks have not been pumped out � within three years, they should be pumped out and risers installed now. y 91 Inspection pipe is located over tank baffle-can not measure solids accumulation. If tanks U have not been pumped out within three years, they should be pumped out now. 10 One or more tanks are cesspools, which means the septic system is non-compliant. (The tanks are [x] or are not [ ] water tight or the condition is [ ] unknoxn. Zf the tanks are not confirmec� to be watertight, this classification is subject to revision.) INFIELD CONDITION (11-14) : 11 . 1 Drainfield is dry, no surfacing evident. 2 Some evidence of surfacing, not critical yet. Repair is not required at this time. 13 Drainfield is saturated and visibly discharginq untreated effluent to the surface. Contact the City Inspector immediately. Repair must be completed within 90 days. 14 Drainfield extent and condition unknown. POTENTIAL FOR SYSTEM FAILURE: (system age and condition, soils, etc.) : medium CO[�IENTS: In order to confirm that your septic system meets Minnesota standards, soil borings were performed to verify a 3 foot separation between the drainfield and the seasonal water table. The separation is 0 feet and the system is non-compliant. Repair or replacement of the septic system is required by 12/31/2008. l�"�" � - Date of Inspection Sep ic System In"p or Note: In the event that this inspection report is used to satisfy the requirements for a transfer of property, this report does not guarantee that an existing system will continue to function properly, but indicates the operation of the system under current conditions. Telephone (612) 473-7357 • FAX 473-0510 CITY OF ORONO �O� Municipal Offices O O Post Office eox 66 Crystel Bay, MN 55323-0066 � � ON—SITE SEWA(;E TREAT�ABNT IN3PECTION REPORT ti ti ��k o4�p ES8 Owner:=)� � Address• � Permit �'e: Dates: �O"/"'� Contractors: � City ordinance nu�ber 700 requires that each on-site seWage treatment system in Orono be inspected on a regular besis. 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 [ ] new construction) SYSTEM CONFORMITY (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 r►hich 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 "Nal-CONFORMING SYSTEM��-A prohibited system; a system located within a designated 100-year floodplain; any system which mey 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 between the distribution device and the limiting soil characteristics. (The limiting soil characteristic � has or (,7 has not been identified at this time. If the limiting soil characteristic has not been identi ied, this classification may be subject to revision.) TANK CONDITION C5-10): Tank inspection indicates: Pumpout not needed at this time. Solids accunulation in tanks indicates they should be puriped out this year to help prevent future problems. Solids accunutation in tanks is at a critical level. 'fanks 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 surtace dischar$e. 9 Inspection risers missing-tanks could not be inspected. Inspection risers (4�� dia. pipe) must be installed �n each tank at next punpout. If tanks have not been punped out within the last three years, they should be punped out now. 10 Inspection pipe is loceted directly over tank beffle (does not give accurate measurement of solids accumulation). If tanks have not been ptmped out within the last three years, they should be pumped out now. DRAINFIELD CONDITION (11-14): D�field inspection indicates: 1 Drainfield is dry, no surfacing evident. Sane evidence of surfacing, not critical yet. 13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector immediately. Repairs must be completed within 90 days. 14 Drainfield extent and condition unknown. LIMITING SITE FACTORS Csloae,setbecks,etc.): POTENTIAL FOR SYSTEM FAILURE (deaends on soils.water table.etc.): � COMMENTS: Date o Inspection Sep ic System Znspector 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 will continue to function properly� but is merely an opinion of the adequacy of the system under current conditions based on the available informetion. This report must be kept on the premises with the system locetion and pumping records. WHITE COPY/Inspectors Flle YELLOW COPY/Homeowner Nov 50 2015 07:27PM HP FaxRusty Olson 7634988290 page 2 Minnesota Pollution Compliance Inspection Form Control Agenty 520 Lafayette Raad North Existing Subsurface Sewage Treatnnent Systems St.Paul,MN 55155-4194 ($$T$) Doc Type:Compliance end Enforcement instructions: Inspection results based on Minnesota Poliution Control Agency(MPCA) For local tracking purposes: requirements and attached forms—additional local requirements may also apply. II Submit Completed form to Local Unit af Government(LUG}and system owner within 1 S days i sySt@CTl StdtUS System status on date(mmlddtyyyy); 11130/2015 � Compliant- Certificate of Compliance ❑ Noncompliant-Notice of Noncompliance (Valid for 3 years from rnport date, unless sho�ter 6me (See Upgrade Requirements on page 3) frame outlined in Loca!Ordinance.J Reason(s)for noncompliance (check all applicable) ❑ Impact on Pubiic Health (Complrance Component #fJ—Irnmrnent threatfo public healfh and safety ❑Other Compliance Conditions(Compliance Component#3)—(mminent fhreat to publrc heaJth and safety ❑Tank Integrity(Compliance Component #2)—Faifing to profect groundwafer ❑Other Compliance Conditions(Compliance Component#3)—Failing to pratect groundwate� ❑Soil Separation(Compliance Component #4)—Failing to protecf groundwater ❑ Operating permit/monitoring plan requirements(Compliance Component #5)—Noncompliant Property Information Parcel ID#or Sec/Twp/Range; 2711823420004 Property address: 1980 Sixth Ave. N,Orono, MN Reason for inspection: Pro ert Transfer Property owner Jim Pierpont Owner's phone: 952-334-3D35 or — Owner's representative: Representative phone: Local regulatory authoriry: City of Orono Regulatory authority phone: 952-249-4600 2-1000 gallon septic tanks,1-100o gallon lift station and SQO square teet of mound rockbed. per city Briet system description: records Comments or recommendations: Certification 1 hereby certify that all fhe necessary informah'on has been gathered to determine the compliance status of thrs system. No determination of future system perfoimance has been nor can be made due to unknown condifrons dunr�g system construction, possib/e abuse of the system, inadequate maintenance, or future water usage. Inspector name: Joseph J Olson Certification number: 1255 8usiness name: R�st 0 son's Soil&Perc.Testing License number: 81Q Inspectorsignature: .' ---- Phone number, 763-498-6779 Necessary or Locally Required Attachments � Soil boring logs �Sysfem/As-built drawing ❑ Forms per local ordinance ❑Other information {list): www.pca.state.mn.us . 651-296-6300 • 800-657-38b4 • TTY 651•282-5332 or 800-657-3864 . Available in altemative formats wq-wwists4-31 • 1/14!12 Page 1 oj 3 Nov ZO 2015 0727PM HP FascFiusty Olson 7634988290 page 3 Property address: 1980 Sixth Ave. N Orono MN Inspedor Initials/Date: J. 0.11/30/15 1. ImpdCt on PubliC Hedlth—Cornpliance component#1 of 5 Compliance criterla: Verification msthod(s): r System discharge sewage to the ' ❑Yes �No � �arched for surface ouilet ground surface. � Searched for seeping in yardlbadcup in home System dischar�ge sewage to drain tlle � ❑Yes � No � ��sive ponding in soil systemlD-boxes or surfac;e waters. I ❑ Homeowner testimony (See Cvmments/ExaanaGon) ❑ "Black soil"above sal dispersal system System cause sew2ge backup into ❑Yes �No ❑ System requires"emergency"pumping dwefling or establishment. ❑ Perforrned dye test Any'�yes"answer above indicates the sysfem is ❑ Unable to verify�see Commenrsgxpranadon) an!mm/nent Threst to Public Health and Safety. ❑ p��meihods not listed(See Commerrts�expranetion) CommentslExplanation: 2. Tenk I�tegr'1ty—Complia�ce component#2 of 5 Com liance criteria: Verffication method(s): Sysiem cansists of a seepage pit, ❑Yes �No ❑ Probed tank(s)bottom cesspool,drywell,or leaching pit. j ❑ Examined construdion records Seepege pits meetrrrig 7080.255o maybe i ❑ Exarnined Tank Integrity Form(Atfach) corn ianf il allour�d in/oca!wdinance. Se�va e tank s leak below their ❑ ��eroed liquld level below operating depth 9 � ) i ❑Yss �No ❑ Examined emply(pumped)tanks(s) desi rted o tin de th. If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"bladc soil" ❑ Unable fo veriTy(See canments/Explanation) Any"yes"snswer above inalicates the �p1her methods not lisled(See Comments/Exp�anation) system is Failinq to Protect Groundwater. Co m mentslExplan ation: See tank report 3. Other Comptiance Conditions—Compliance component#3 of 5 a. Malntenance hole covers are damaged,cracked, unsecured,or appear to strudurally unsound. ❑Yas* �No ❑Urrcnown b. Other issues(efectrreslhazaros,etc.)to immediately and adv�ersely impacl pubNc heslth or satety. p Yes* �No ❑Unknown 'Sys(em Js an fmminent thivat to public health and satety Explain: c. System is non-protective of ground water for other conditions as determined by inspedor ❑Yes* �No 'System is fa1!!nq ta protectgr�nundwater Explain: www.pca.state.mn.us • 651-29b-6300 • 800-657•3864 • TTY 651•282•5332 or 500-657-3864 . Available in alcernaiive formats wq-wwists4•3f • fl24/f2 Paqe 2 of 3 Nov 30 2015 07:27PM HP FaxRusty Olson 7634988290 page 4 Property address: 1980 Sixth Ave. N,Qrono,MN Inspector initials/Date: J.�.11130/15 4. SO�I S@pd�dtioll—Campliance component#4 of 5 Date of installation: 1111/2010 ❑Unknown Ve�ification method(s): 3�h�orolandNNallhaad protecdoNFood Bawrage �Yes � No Sol!observation does not expi�.Previous soi! � g observations by two indspendern parties are s�lficient, COmplianCe C�'iteria: un/ess site conditfons have been altered orlocal For s sfems builf requi�ments differ. y priorta Apn!1, 1996,and � ❑Yes ❑No notlocated in Shoreland or WeJfhead I � Conducted soil observation(s)(Artecn bo6np►o9s) Protecfion Area ornotserving a food, � ❑ Two previous verifications(Attech borfng�ogs) beverage oilodging establishment: i ❑ Not applicable(Holding tank(s),no dral�e7d) Orainfield has ai least a two-foot vertical � ❑ Unable to verify(See Comments�xplenat;on) separatfon distance from period+cally � ❑ Other(Ses CommentsrLxplanadon) saturated soil or bedrodc. ' Alon-perforrnance systems bailt Apri!1, �Yes ❑No Comments/Fxplanation: 1996,orlaterorfornon-periormance ; systems located in Shorn/and orWeNhead � Protec6on Arieas or seiving a fnod, i beverege,orlodgingestablishment� ' Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock" � 'Expe»mental'; "Ofher;or Perfamance" � ❑Yes ❑ No Indicate depths of eie��tions systems built under p�-20�8 R�les;Type fV or V systems buift undar 2008 Rules(7080. � A. Boriom of distribution media � 99.4 2350 or 7080.2400 (Advanced tnspedor i i License required) � B. Periodical saturated soil/bedrodc 96.4 Drainfield meets the deslgned vertical C. S stem se aratlon 3.0 separation distanoe from periodically saturated soil or bedrodc. D. uir�ed com liance se ration• 2.6 Arty"no"answerabove indlcates fhe system Is -�y��uoed up to 15 pencent if allowed by LoCal Failin to Protect Groundwater. Ordinanoe. 5. Operating Permit and Nitrogen BMP*—Compiiance component#5 ot 5 � Not applicable Is the system operated under an Ope�ating Permit7 ❑Yes ❑ No If"yes",A below is requlred Is the system required to employ a Nitrogen BMP? ❑Yes ❑No If"yes", B below is requlrod 8MP=8ast Msnagement PracGce(s)spe�ed in the system desigrn !f the answer fo both questions/s"no", fhis section does not need to be completed. Compllance criterla a. Operatir�g Permit number: � Have the O ratin Permit r uirements been met? ❑Yes ❑No b. Is the required nitrogen 8MP in place and properly functionina� � ❑Yes ❑ No Any"no"answer lndlcates Noncompliance. Upgrade Requirements(Minn. Stat§i 15.55)M imminent threat to publiC health and sa}lety(ITPHS)mustbe upqneded,replsced,a its use dlsConGnued wifhrn ten months of receipQ of this rratice or within e shorter periorl if roquired by local ordinance.!f the system is fa/linq to prolrcl ground water,the system must be upgnaded,rep►aoed,or its use dlscontinued wifhin the time�equired by loCal oNinence.lf an exisdng system Is not feDing es deflned in lan;and has at/east hvo feet of design soi!sepaietion,then the system»eed»at be upgraded,repaired.repfeced,or lfs use discorrtinuerl,notwithstandfng any loca!adinance that is more strict. Thrs provision does not apply fo systems in shoreland areas, Wellhead Prvtection Arees,or those used in Connection with ifood,beverage,and fodqrng establrshmer►ts as der�ed in law. www.pca.s[ate.mn.us • 651•296-6300 • 800-657-3864 . TTY 651•282•5332 or 800-d57-3864 • Available in altemative formats wq•wwlsts4-31 • 1l24/12 Poqe 3 of 3 Nov �0 2015 0727PM HP FaxRusty Olson 7634988290 page 5 Pumpin� Repnrt �e�r-er Ser�'1Ces ;\1i�34ti��t l�rtr�:hl��,. ti►��:cil�ii��i �,ulli�:tn:`t�h,►�mcrt) , _.__ _. _ � � I)atc ��:n ic��i: ��- IC)� � _ t)ri��r�, `,iSill: � ! �_ _. 1 K�a�izl. � t�i�in�tiir��3[: �l:lr�t: F�initih: � �._[�pr ��1�Scr� i��', it�.Ju3ur 'll:�iut��n,t�t«: � �mcr:=�ni�: _ � . � _...._ . i 1:�rt��. � �+:;�.rnpa ��i�.% ��. . :i��,.: ��{� ��. . �7� �vr_ � C�f��: �1ren,:; __ ti:�ll�nti i'uitt��; �l�:�ni� %�! ��,�Qv l ari� -�' i�� f'um� I :inl: �;i tat��l Gr-��t) :'14t;4;, �'scii li�r Pui��it�i;�: "►�1►il1<�1� Stai�d�i��; (F�.��,I::ri:►ti��n7: �Tar�}. C'«��ditic�r� ��.� I'�id�:t�c �}t f'rc�hl�rn�� ;ti� .8 � �: �� ( , ' � ('c�rtir�t�'rttti: LX,�'1"t� -�� l�ev a � _..C�•� . 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