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Home My WebLink Aboutseptic info 5 i � ) , 3"'�t$�"2: ��;�;'�-� 1Vlinnesota Pt�llution Compliance ins ection Form .�,r,.:r..4 � N% �� .Y Control�genty szo t.afayetce�.oaci North ��gting Subsurface Sewage '�reatment Systems� s�.�au�,MN 55155-4194 (SSTS) 1Joc Type:Compliance and EnforCement Instructions: Inspection results based on Minnesota Poilution Control Agency(MPCA) For.local tracking purposes: requirements and attached forms-additional local requirements may also apply. Submit completed form to Local Unit of Government(LUG)and system owner within 15 days System Status System status on date(mm/dd/yy.yy): ❑ Compliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance (Valid for 3 years from report date, unless shorter 6me (See Upgrade Requirements on page 3) frame outlined in Local Ordinance.) Reason(s)for noncompliance(check all applicable} � ❑ Impact on Public Health (Compliance Component #1)-Imminent threat to public health and safety ❑Other Compliance Conditions(Compliance Component�i.?)-Imminent threat to public health and safety ❑Tank Integrity(Compliance Component #2)-Failing to protect groundwater � ❑Other Compliance Conditions(Compliance Component#3)-Failing to protect groundwater ❑Soil Separation(Compliance Component #4)-Failing to protect groundwater r� .,.,_;_..; u �N��Q��y�c�„��ti�n�r�iiu�iny pian requireinenis(i;ump�iance�omponent #5j-Noncomplranr Property Information Parcel ID#or Sec�fwp/Range: Property address: 3��0 - �'D, 1e.Q •�p Reason for inspection: �,�! - � Property owner: Owner's phone: or Owner's representative: Representative phone: Local regulatory authority: C� � d Q iQ0�o Regulatory authority p one: Brief system description: �-/p0 r/ 9 �� j�w�c� � �s� ��f'yJ1�e...- - /�D��('(�� (�� Comments or recommendations: Certification I hereby certify that alI the necessary information has been gathered to determine the compliance status of this sysfem. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: ,LE11.9 � �y.��,� Certification number: 7S6 Business name: /y[E ��L o 4aL f � 1',�,f ��,�„� r a� License number: �L/ Inspector signatur . Phone number: �C�- {/7�- /7,C-o Necessary or Locatty Required Attachments �Soil boring logs [��tcMAs-built�drawing ❑Forms per local ordinance ❑Other information(list): �T � �� f � Property address: 3(�.,5�� Inspector initials/Date: O',� 1. Impact on Publie Health—Compliance component#1 of 5 Com liance criteria: Ver' cation method(s): System discharge sewage to the ❑Yes [�No S rched for surface outlet round surface. Searched for�seeping in yard/badcup in home System discharge sewage to drain tile ❑Yes �No � ��ssive pa�ding in soil system/D-�xes or surFace waters. ❑ Homeowner testimony(See Comments/�xplanatlon) ❑ "Black soil"above sal dispers�l system System cause sewage backup into ❑Yes No � System requires"emergenc}r'pumping dwelling or establishment. . � ❑ Pertormed dye test Any"yes"answer aboVe indicatas fhe�ysfem is ❑ Unable to verify(See CommentslExplanallon) an/mminent Threat to Public Health and Safefy. � p�er methods Flot listed(See Commer►t�xp/anation) Comments/Explanation: 2o Tar1k Inte�rity—Compliance component#2 of 5 �j,y �� --.�o� ` �— Com liance criteria: Verification method(s): System consists of a seepage pit, ❑Yes ❑ No � Probed tank(s)bottom cesspool,drywell, or leaching pit. ❑ Examined construction records seepage nits�meeting 7o8n 255n mey be ❑ Examined Tank Integrity Form(A:taah; r,omnliant if allowed in local orrlinance. ❑ Observed liquid level below operating depth � Sewage tank(s)leak below their ❑Yes ❑ No � Examined empty(pumped)tanks(s) � desi ned o eratin de th. If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil" ❑ Unable to veliiy(See Comments/Explanation) Any "yes"�rlswer abOve indl'Cates#he � pther methods not listed(See Comments/Explanation) system is Failing to Protect Groundwater Comments/Explanation: 3 a Oth�1'GOIllplldnCG COndltiOP15—Compliance component#3 of 5 a. Maintenance hofe covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes* ❑No ❑Unknown b. Other issues(electricalhazarris,etc:)to immediately and adversely impact public heafth or safety. ❑Yes" ❑No ❑Unknown "System is an imminent threaf to public health and safety Explain: c. System is non-protedive of ground water for other conditions as deterrnined by inspector ❑Yes" ❑No *System is failing 4o proi+2ct groundwater Explain: i , � � Property address: �O�j Q. �p� � � Inspector initials/Date: 7 4. Soil Separatio►l—Compliance component#4 of 5 Date of installation: Q �� ShorelancUWe��head protectioNF ❑Unknown Verification method(s): Lodging? �d Beverage ❑Yes No Soil obseivation does not expir�. Previous soil Com 7118nCe Criteria: obseivations by fwo independent parties a�e suficient, unless site condifions have been altere�f orlocal For systems built prior to April 1, 1996, and � not located in Shoreland or We//head ._. 'es ��o �QU��ments difier. Protection A�a ornot senring a food, ��nducted soil observation(s)(Attach boring logs� beverage or lodging establishment.• �'�wo revio s verifications(Attech boring bgs) Drainfield has at least a twafoot vertipl ❑ Not appli�ble(yolding,tank(s);no drainfreld) separation distance from periodically ❑ Unable to verify(See CommentsiExp�anallon) saturated soil or bedrock. ❑ Other(See Comments/6cplanah'on) Non perfpm�ance systems built April i, >996, or later or for non perfoimance ❑Yes �o Comments/Explanation: systems located in Sho�land or Wellhead ProtecSon Areas orseiving a food, beverage, orlodging establishment.� Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.' 'Experimental'; "Other'; or "I'ertormance" systems built under pre-2008 Rules; Type/V �Yes [�No Indicate de ths of elevations or V systems built under 2008 Rules(7080. 2350 or 7080.2400 (Advanced Inspector A• Bottom of distribution media License required) Drainfield meets the designed vertical . B• Periodicatl saiurated soi�lbedrock I separation distance from periodically saturated soil or bedrock. �• S stem se aration Any "rro"answer above i�dicates the system is �• Re uired com liance se aration' �y N Fai/in to Protect Groundwater. May be reduced up to 15 percent if allowed by Local Ordinance. �y �L�f a.£ i°w4 � �• ,r �%�� 5. 0perating Permit and Nitrogen BMP*-Compliance component#5 of 5 � , Is the system operated under an Operating Permit? �-, '°"`aPN��cable Is the system required to emp►oy a Nitrogen BMP? �Yes [� �f��yes",A below is required BMP=6est Manaqem�nt Pracfice(sJ specifred in fhe sys�tem desig�n� If"yes", B below is required lf the answer to both questions is "no'; this secfion does not need to be completed. Com liance criteria a. Operating Permit number: Have the O eratin Permit re uiremenfs been met? ❑Yes ❑No b. Is the re uired nitro en BMP in lace and ro erl functionin ? Any "no"answer indicates Noncompliance. �Yes ❑No Upgrade Requirements(Minn. Staf.§115.55)An imminent threat fo public healfh and safety(/TpHS)must be u discon6nued within ten monri�s of recelpt of this notice or within a shoiter perioUr if ground water,the system must be u o � required by local ordinance. lf the�em�ap g ro pro ct� is not failing as defined in law,and has at least Iwo feet of design soil separation, then the system need not be upgraded,re a)re P9� er1,ioplaced,or its use discontinued within the time nquired by loca/ordinance.lf an existing system its use disconNnued,nohvithstanding any local ordinance that is more strict This provision does not app/y to systems in shoreland areas We/lhead Protection A�eas,or those used in connection with food,beverage,and lodging establishments as defined in law. p d�p�aced,or ro.pca.state.mn.us • 651-296-6300 e ��.,:..._., �, .,... 800-657-3RFe . ,�„.... --- 19:34 7634988290 RUSTYS PERC TESTING PAGE 05 , ��— , � • Lna�a�SQ�� 910 �a p�t 3p5p Cpuriy Roed�8 �� b,r; �p�s S�oM s�nd Prrc!� Cl�lll�ation S� � : UI�-118D��.X—� � ;OII�_.._ �pK us�d(qNct two):H�nd_„X___�or Po�wr...��.8udc�t or P�obs� �� 1_Suctac3e ele�vadon 96.1! Mc�tled So�at 2.5 ieeet 0�"l�o�n�d e�d 1� �� 2�D�rlc brawn laam �OyM� ZO'�30�'B�+a�m cJ�►b�rt+��Y�'� 30''-38'Ruet,Y b�lo�m 10y�1a Nbttled Stail s�1.1_f�t �� 2 �eleva�inn 97.0 �0�at X teet 0`�'Dsrlc brvwn bam 10yM� 4"14'B�oMm doy lo�m �O�14 14'-�RustY��Y��4 . . � �, , , ; Parcel number. � � System shatus: �ompliant ❑Noncompliant (as detemrin � - � ��s.� 1�.$1:��1. ' .5:�,='A�#�dael, �.11��.�. .6 : Tank Integrity and �afaty Compliance � � _ Compiiance Issue#2 of 4 � � O- !�� e ��-a �� Date of observation: � 'O ' Reason for observation: - � This form expires on(three years): �'—g� �� . Compliance questions/criteria: (Required) � Verification Method"`:�(OptionaQ _ Check the a ro riate box � (Chedc he appropriate bdx) � Does the system consist of a�seepage pit', ❑Yes o ��nk bottorri . ` �cess ! d II or leachin it? - . , _ Qo any sewage�tank(s)leak below their. �Yes No � Q Observed low liquid level . desi ned o ratin de th? � � -Exa ined construction records . � . if yes,identify which sewage - _ . Examined emPty(Pumped)tank - tank leaks. , � � � � , � Probed outskfe tank for"black soil' Any"yes"`arrswer indlcates that the system/s failing to protect - : . ground water.� . . ❑ Pressure/vacuum�chedc � . . . _ � - . � ❑ Other: � � ' Seepage pits mee�ng 70802550 may be compiiant lf allowed � . in 9rdinance by.local permitting'authority. . - - - � • "No standanl protoco!exists. This list is not exhausfive,in� ` : � sequential o►der,rror does it indlcste which i�mbinations . ' . � . ais ner.sssary to•inake-this determination. . � : _Safety CMeck - - . : � � : 1. Are any maintenance hole covers damagod,�cracked,or appear�ed to be structuraily unsound? 0 Yes' � _Nb� ` � . �2. Were all�maintenance hole covers replaced in a secured manner(e:g.;all sc.�ews repiaced)? �_. . Yes ❑No*. 3. � Was secondary access restraint present Fsafety pan;second cover,or safety netting)—highly�ecommended. ❑Yes Ll ryo 4: Was amr other aafety/health issue preaent? . : - . . - ❑Yes* L�'IVo . Exp{ain: � . - — . *System is an Imminont�reat to publlc healdi and ssfety. . � Certification � . � This fonn is to be completed and attached to the Summary Form of.the Minnesota Poliufion Control Agency's(MPCR)-Compiiance Inspaction Form for Existing Subsurface SewageTreatrnent Systems.Observationsr�interpr±etatwns.and conclusions must be_�. � completed.by an inspector,maintainer,or servic�provi8er.Completed fortn mus!be submitted to the local unR�of govemmQnt within 15 days. � � � . • � , - � . . Property owner name(s): l�/1 Gr�« i �� dy . . Property address: '`�O Sd �� • Rd lP . -� Property owner's address(if different): _ � County: Phone: � . 1 heieby certily that l personally made the observations, interpretstiona, and conclusions reported on this foRn and that they are comecr. - � � � Name: � i r1, � �h Y Certification number. �-a� �7- . . � � ' Business license name and number. � h rj��1.L ,�Pr'ViCP: �� - ��_�" or . � Name af txal un' ovemment: � : Signature: . . Date: �g" � � wq-wwlsts4•31 . _ � Compliance Inspectfon Form for Existing SSTS e��inR - 09/07/2067 19:34 7634988290 RUSTVS PERC T�TING PAGE 62 , _..............._....__ _ . , � �N � r Re�r o��N�s so�� o �c.�M� 11481 R'nterview Rd. NE � HANOVER, MN 55341 Phone 763-498-ST/9 � Fax 763�98-8290 Joseph J. Olson—MPCA lioense�810 s�r�r o�,2om Melodie Martin 3050 6"'Ave,N. Ororzo,Iienne�in CouatY To whom it ut�ay oanoern, Z wes oon�.rted by t�e Melodie Meriin bo pe�fotm a Septic ceitificstion on the p�periy at 3050 6tl'Ave.N.In th�e City of Orn�o.Th�e results of the Septic certificatian are as follows. Soi�boriun�oa tbe pm�pecty at 3050 6°i Arre.N.Indicebe that t6e Saptic system does oonfarm to t�e two foo�t sepa�atio�,xu1�e finma the high water table.Th�ore�t�e exis�ng mound syste�is in a staLe af compliaawe to the oodc Ch�7080. Soil boring# l Elv. -96_1 mattled sails a�Elv:96.3 SoiJ baring#2 Elv.-97.0 mo2tl�od�ails at Elv. -95.9 Bouom o�the existing approx�mmDe10' X 63'roc�bed is at Elv-97.3 Original soils w'der the mckbed a�+e at Elv:96.3 Original sails arouad the sysbe�are n�ottled 1430 iincb�belo�r grade- �you h�e any quc�ans plea�e csll. Sin+eexely, Joeegh J.Olson 09/07l2007 19:34 7634988290 RUSTYS PERC TESTING PAGE 03 , ` . yya�er LST54.31 1/29/02 �'' Co�npliar�ae insped�ion For�m for �ng M��«od po�on Individual S�eiwa�ye Tre�tment S�stems Careroi�► can�prs�on of�hts fdm,ru�Ma trn mrn�n.r►�equre+ner�r all�r,n.srdt§��d►�a(200�)ara ll�rm.soce 1t.on.�os��. Pl�..ss �ei�r b local or+�'rer+os�Nor o1Nar rev�rr�a�a arinlb+nre�ar�a�ofe�i►Ibrooml�r�oa�pu�e�srMs lror bsd►narn sddb�ona. �. D�b d I�O�O%�o7 REA�ON 1br drp�lo� �Iw'al�ts) �r.�.... TMMd�aM( )� PMsor,�,wdiq i�■pac,tlons _ Me�os�we�un 7'�NPhon�(di� 7�-I�! �Ir Ad�a� Oby' � �n C°d�,�— Ftre Na/Pr+oM No. �■�H�i.. T°"� �rs�l D��tlon ��q�C1�r d donQ D�6�i/rllrl t�ll�'11L�Ik 9/27/1�3 _ �111 Nf 9h01+�d Mis �!s �IO �11111�1Sd P�O�d'1�1 A�� yCS �i0 �11/fY�llO a MON�wd� �'+ fl0 �rOCN�t��If��- 9y�ten�bdit w�io�r to AprM 1, 1996 s11d nOt bcabed h 9ysUentS bCe�ed In S1�o�elend or VMeIR�esd Prot�aCtfon Statd�d or We�ead Pro�ctfon Ate�or Seving a Food, Mess or Servk�g a FooO. Be�'a�or tadglnD Bew�erapR or Lcdgirg E�li�merit Est�ablisM�an�,or�8u1t a�er M�rd�33 1996 �(arsar�arlcanlTAkssys�aml �C�3.�a�arawerBanl�ss�rn) -ol�d�ge af ser�age b ehe grrx.d surraae7 VEs -oi�dtier�e af�ewa�e oo me gra.d s,rfaoe? YES No •Ol�d�qe af sew�pe b�alnue a surfaae v�es? 1RS -Oisdis�pe d sew�e 0�dr�Nitlle or 5u'faoe waber�Ye5 NO -5ew�gs bsdaq It�o dw�e�g� rE5 -Sewe�e bec4ip Inbo cirwa�rg't 1t�5 NO -9lwlfon wNh the pobeMiel to ttMned�eiy and -Sb�efon w�h ehe pober�ial 1�imm�y�nd ad�ey ImpaQ ar dN�p�c h�aNl�or adre��ey it�ect or tlYea�l�en pubqc t�eaMf�or sd`ty? Y@S� 3�eq►? YES NO �% a yes arerwer k e 1�I i►�s�smmJ a yes ar�er Is a�aAh�p sy�(ern) -ts�tlisn!Np t�eet of ve�ctl sape�lfon b�ween -Less t�fien TfU!!�E�eet af vartiml aepara�tlon belw�een s�lseem bol�oln arld salualed soY ar 6e�od[t 1�5 9�n batfom and�urabed soil or bedra� YE5 NO '��Oe�PR��Pod.��a lead�kg PX'� YLS -A see0spe P�.ae9aDod.drlrM�eA�or I�ddnO pR't lfB NO -Is 1he syr�em�ed under a monNo�p pl�n ar - b 1he �m r+egul�ed under a mor�orfn�p pl� or ��A P� f��►8p b l�21 1�� P�(��p�b P��1 Y6 NO �'1�r Kl�. -!�s Ihs►e�t�lned mor�lorinp�edoen pleoe? 11g NO -lies fhe requ�d nw�OotMp t�ken plwoe? YES NO (If n411�s�rr,is noRcon�f� (�nq�e aye�lbm/a -TI1e m�kldk�l!tllat tl19 8y�91D f tla8�i -Th�111011�D1'�fl�h1�e i�1he sy6�fT11T1� ��X�'.'�011t'r � 1� �Oflll�{'1pe��'� YL5 NO ��. �sy�� (�/!0. UI!1y�1[I1111 AOQ�oOA'�ly�/� PagE 10f 2 Wq�wWISt�.31 09/67/2007 19:34 7634988290 RUSTYS PERC TESTING PAGE 04 '�r��s� �d� �e�A R�w N. �dIB 5�►11 CE�J� . ' 1NI��atNoir wrs��s��tl�s � I�or 1M��IMo s'�►�d�rdpol�aodawa�is The halbwi�D�t�riwted�dM�nat't►�q�en�laabn�ar�x�ca�s MIMwi�arenec�ary e�n�aaboerni�e�far►I o Pr�obed tsnic botbom • se�d�ed for wrfaoe autlet • Cand�x�ed so�bor�gs 0 obosva0�ow ilquid IsMd o PManhed hydra�C�t O�D�m�� St � 6�ni�ed mi�t reoord� • see�d�ed 1br�e�plrg In yad �m sY�� f ��P�1►�P�PedI� O fJ�edoe�d far 6sdciq in hOnle D D�n�ifed neooirls O Probed a�bnk I�r"64d��ai' 0 6aoe�sNe pan�q In sdl�booaes o LGIJ Uni�g LayQ VsN�tl� O PrB�/M��clied� O NommMier bd�#ino�N O Otlrr 0 other o D�nrned 60�s�rgirq In t�nk o •Bdd��oM"atio�sdl s+y�em a olher ��s al`tl1a a��em y�od m tl�s aoaplfinos aibsl,,!f�s�pbrp�a�s Ma (dt�dc one� Ll fa�ng(0�pnc�e�9rounOw�eR�er) C] an iim��t fhe�t io pub�c hea�h or sel'�l(ITPFi�. O notrCamPlfanR(monlhai�tg fs�us� ■oom�(na»f tne 3 qeNous a�fons� �s tli a�M�a!!�/►t1■s V L�chae w�all'r O y�es � no 71�arabe+�.dMr doaMnent�s a:�t�lasbe cf Gorrql�ioe O Notioe af NonoomDllanoe i�e�a sla0e af Mirna�ats liau�ed L�Pecbor an�la'Desipner I or$�eiflad�nployee In�ecbor and/a'Q�Iled Hriplo�y�ee D�erip��I tltet I md��d�n im�esfl�fbn tl�at amrabel�►deleni�ed tAe aomp�e�we�aEus af tl��n and that my reoarded c0�e�vatlore a�e aoc��rab�as af Urs d�e. N�ddar�ninMlon d1l�uie IrydrauM�perf�rtnsioe I�sa Deen nor can be made due to unlv�own aondiioi�s disiig sy�em ao�On�iton,abusc of the s�r�len,inde�qe�nri�w�a�i�re wamr use0e. �i�,7��i��/ ��rw�r�� w�■ f�RA�i.�� En�b�ed Iry: , �ddra� iLYi�IrsMsir Ile�d�._!1■■a��r MN.�1 sg�.e oea� ,nio� lalmrl�edlia�i�Is,e�iais j I1S�3� Mll1!'LS�xetLle t�rader��qa�car�ar�ta�a1�viEfanedwidiir d9n naar�fhsof�dlJits/�aace ow�d1bi a s�aart�rpe�►I�ou/� �eqriedbr�tod o�an� aer.ssy�am a�Cmpa�ide s�Mlla�enrgre�d�Eerp�a�fa�y err�,er�s�a�d�rn�rae t�►a� �e�oeld arL�we a�r�G�x�ed a+E►M7 El�s��e Ieqli�d bylt�Qr�1B bid a��cE D'i��3�m,l�n�d IPMiq a�delhedh 4w,and/aas'atA�tt�Ibri'crd�nsd�qoana�far;�tlls�nednd�G�e ipgrad��ur�reas a6�a�r,�,i,r+er;aabr�dr,d�,�anY�acalwd►wicell�tL�n�aresb�L 7/�da�raota�p��b�hs�inramrdarear,�d pol�bn ai�C ordia�r rdedh mrnaeahiar��Eh�Mtss�ardkaf�ig�a�ddi,edii►►Nw i) S�e�a�d�wNld�Indude6 ihe�n bca�tlon(mardMorl►� OUier�ris oot�id�ck�d�wei�,well sptl�adc��rm.dwa�'g a' aM�er tiubnps►t�nkis),ra�'wd sdl tie�ebnor�t an�,surf�ce v�al�r and so�bo�inp loasdoe�s. IntNide ss�bupt ba�wMg I�s�Dte. 2� sor bai�9 bgs„shawrq awch horl�on. IndcAOe ths�aWr�e,eolor,+ed�drnarP��+��m��k�D rw�er end whatl�er Uie n�eiYl�f�. 4) A�hanieo��er a�►afsyqen dpvbmanoe.sipned b�►the hatneow�ier 6dnII fimial. �d�ened�on tl�s I�oe�n. Page2ufZ 09/97/2067 19:34 7634988296 RUSTYS PERC TESTING PAGE 05 , � LIoN��10 L�ocMion or Proj�t 3Q60 Cvwri�►R�oad f 6 Bo�Nps nnd�b�: RuM�O�ti 8�p�d Pwe M�KI � Cl�tbn S� AA�� : IJiD�-1�� : � -'�--- Au�r ir�d(�t b�rp�I��nd_,��o�Paiwrr__,_.F�i�f+9u�lwt or P�ob��_ 8o�kg Nu�nber 1_Su�terc�e eie�vsdon 96.1_ Mdtled Soil�2.5 fee� �'Loam and serd 1� �P��--� 20►'Darlc brown loern 10yr412 20'30�Bra�m dey bem 10yr514 ��9"Rus�y b�vwn loom 10yr514 8ai��g Nun�6er 2 Swfios eleNsd�on 97.0 Mc�lled Soil a�1.1_feet 0'-+1'D�mk btown bam 10yMR H20 pre�errt at X teet �"1�'Brown doy lo�m 10yr514 14'-�Z'Rusiy browrl day Io1N't�10yr�.i/4 09/67/2007 19:34 7634988290 RUSTYS PERC TESTING PAGE 66 A A?o ' ' `� _ r � . � � S� �~.� / a. � a ' 6,r. k � N y� � � k fi�� / r � \ ��I V��,t,r�Y •O � P � � � � � ° ' � � a . � �� y� ��,. � � • � � � 1 � '. --� �� ► � � � � � . � � �� .�� . �:� �� ,,= � � � - �; = d � 09/07/2607 19:34 7634988299 RUSTYS PERC TESTING PAGE 97 • _- - Sep'07 07 06:32s Kethleen 763-497-276a P�1 � DUANE BARTHEL � � 105p�2 31 st Pl, N.E. . St. Michael, MN 55376 . Phort�: (763) 497-2764 0 � . S@ptlC S��Y�C� MPCA Lic. # 654 � DATE - 1�-O � IIVSPECT ION NAME O e s ga�� ADORE3S . ?� GITY r0 fl STATE ZIP SEPTIC TANK INSPECTfON FORM: � Numbsr af Tanks: . 3 GaVTank: , loao � Tjrpe � System: Mou�d ✓ Tr�nch Other ____. Cement 9otto�m: Yes _�,�,. I�co : Beifles in Place: Yes ✓ No � Watertight: Yes � No Water Level Good: Ybs � No Tar�ks mest townshfp &c�ounty requirements: Yes � No Comments: �c W�rK�'�o o Y e�r.�r- � � Sipned By: � _..._ . � ' � � � � ,,o O.. i�� `��`� CITY of UItON(� � '! "'� � �, jl Municipal Offices . ,� �' ' � • � � : '� ' � ' ;''' G ' Street Address: Mailing ftddress: �9kEs��'Q��; 2750 Kelley Parkway P.O. Box 66 �` Orono, MN 55356 Crystal Bay, MN 55323•0066 To: The Current Owner of Address �`�C� �� `�`� � 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 compoilents 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 receipt 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�ump out Needed Yes ✓ No The City recommends the septic tank(s) and/or lift tank be serviced and pumped out every three years. City records indicate the tank(s) were last pumped out on ' �• � " G� . The tank(s) should be cleaned through the manhole and I not tluough the inspection pipes, this allows for proper cleaning. Comments: F-�^ Inspecto � � � r�-p�'�"�,�, Date of Inspection C�'"�' � 'Il'e9ep�one(9g?12�9-4600 � �'ax (952)2;9-�6��fi www�.ci.orono.mra.us __ ____--------------- �O� __ O ,:.... . O �-��} � CITY of ORUNO �� '��,y �f+�, � . M�� ' ��' G� {,�'v''�¢F .�,� ��► Street Address: 95a-�49-�'16o O I►uilina Address: �[',�gg0 2750 Kelley ParkwaY p.q. � � � Orono, MN 55356 Crystsl 8ay, #MV 55323-0066 To Current Owner: Address: � �� S'�� t- N• Gity 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 fail into the categories checked below. SYSTEM CONFORMITY (1-3): j _ «-_ _ —- =- - .r,... —. . . --._... .__.._. . _..___ . _ 1 CbDE�SYSTEM"An ISTS which meets all the location,design and construction standards of the ciurent Orono Ivtunicipal Code. 2 "COMPLIANT SYS`I'EM" An ISTS which does not meet all the location,design�d construction standards of the cumut Orono Municipal C,ode but dces meet the three foot separation requir�eat or two Eoot require�ent for systems installed 1996 or eadier,and which is not�iling or an i�in�t Wreat to public health or safely. 3 "NON-COMPLIANT SYSTEM" A prohibirea Is�s;an rsls located within a aesignatea 1 oo-year aooa plain,sny ISZs w�ich may or may not maet all the locarion,design,or conshuction stan�rds of die curre�t Urono Municipal Code and wluch is failing for any reason;and any ISTS with iess than duce feex of unsaUrcaked soil or sand between the distdbution device and tbe limiting soil characteristics. TANK GONDTTION(5-'n: � Tank inspection indicates: � 5 1'umpout aot needed at tlus time. ��Sepiic tanks must be pumped out dus year (city code recommends tanks to be pumped out once every 3 years. Tank was last p�mped �S'�—�Z ). Make sare sentic#aeks are oa�ned t�roa�b maahole sad not throu�h white insnection�ioe,s. T4is allows for t�e nroner cleaeing. Keeu�vater aofteer sad iran S►ter dischar�e out of se�tic svstem to nraloa¢life ef drai�field Ask onmuer to test alarm float to verifv�Isr�is sti11 workiag in voar�ouse The alarm warns ow�er tYst sentaee is abuut to backun into basement 7 Inspection nsers missing-tanks could not be inspecfi�ed. Inspection risers(4"dia.pipej must be installed in each tank. If tanks have not-been pumped out within the last three years,they should be pumped out now. DRAiNFIELD CONDTTION(8-10): � � �Drainfield is dry,no surfacing evident � 9 Some evidence of surfacing,not critical yet. i 0 Drainfield is saturated and visibly dischargiug untreated effluent to the surface. Contact the City Inspector immediately.Repairs�nust be completed within 9U days. co�s: ,.�� o oks �k_ P,,�p - S��P�-=� -j-��c� s v�.,�� 2.� o�- . �0\y_o� ��v,� �� Date of Inspection Matt Bolterman- Septic System Inspector Note: In N�e event Wffi this inspection report is used W satisfy thc re,quir�ents for a mortgage or Wha trmsfea of P�P�Y,be a�vieod that this repott dces not g�arantee or certify Wat an existing system will oontinue to func�ian P�P�Y, but is � �elY oPinion of ffie adequacy ef the system amd� cwrent conditions b�sed on the ava�7able�formation. o � � � O�q�= O ' . ��? CITY of �RONO �" iy�'.4�1�`'�� S" Munlcipal Oflic - � ( � ;. l �'!:��1�g�G ' Street Address: Mailing Addreu: .. .ii K . 2750 Keiley Parkway P.O. Box 66 � Orono, MN 55356 Crystal Bay. MN 55323•0066 • 95d-�yq-4600 � To Current Owner: Address: 3 d�b S`X�'� �v�.- N � Ciry Ordinance 199 requires fhat each existina 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 appears to fall into the categories ehecked below. TEM C0�IFORMITY 1-3 : � � 1 CODE SYSTEM"M ISTS which meets atl the locadon,duign and eonstruction standards of the eurrrnt Orono Municipal Code. "CO1�iPLIANT SYST'EM" An 1STS which dou not meet a11 the location.design and construction star►dards of the eurrent Orono hiunicipat Code but doa meet the t}uee foot separatioa nquirement or two faot cequutment foc sysums irutalled 1996 or earliet,and which i�aot failing or 'an irtuninent threat to publie health or safery. 3 "NON-COMPLIANT SYSTEM" A prohibited iSTS;an ISTS located within a daignated 100-year flood plain.any ISTS which may or may not meet a11 the location.design,or eonswcdon standards ot'�e e�u[ent Orono Munieipal Cade and which is fa�'ling for any reason;and any ISTS with leu than three feet of unsatvrated soil or sand between the distributioa dev3ce and the limiting soi]characteristics, TANK COWITION(_�-:71: S� � �T insgection indicates: � . . . Pumpout not needed at this time. � 6 Septic tanks must be pumped out this yeaz (city code requires tanks to be pumped out once every 3 yeazs. Tank was Iast pumped_ $-�- a 1 ), • rlake sure sentic tanks are oumoed throuah manhole and not through�vhite insoection oines This allo�ss for the proner cleaning. � 7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)musi be installed in each tank. INFIELD CONDITI0�1 -1Q ; �j 8 Drainfield is dry,no surfacing eviden� 9 Some evidence of surfacing,not critical ye� , � 10 Drainfield is saturated and visibly dischargina untreated effluent to the surface. Contact the Ciry Inspector immediately.Repairs must be completed within 90 days. CO�IENTS: /�^a,�^c� �� `��-.�. �k� �ac�c_ �K-_ � p -R-4� � Date of I�spection Matt Bolterman- Sepdc System Inspectoc Note: tn the evcnt that this inspection report is used w satisfy the rcquiremcntt far a moctgage or othet transfer of properry.be advised that this tepoR doa aot gua.�.1��- C[Ctf�IEY L�11I d1l C!CIStIfla rystem wi11 continue to tf�nction properly.but is merely an op inion of the adequary o f ehe system under eucsent eonditions based on the available inCocmation.