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►utinnesota Poiiution Compliance Inspection Form
- Control Agency
52a LafayeYte Road North Existing Subsurface Sewage Treatment Systems (SSTS)
St.Paul,MN SS155-4194 Doc Type:Compliance and Enfor�ement
RECEIVED
InspeCtion results based on Minnesota Pollution Control Agency(MPCA) For local tracking pu�SZ � 101�
requirements and attached forms—additional local requirements may also apply. I
Submit completed form to Locai Unit of Government(LUGj and system owner cfN�F dR�NO
within 15 days �
System Status
System status on date(mm/ddlyyyy): 3J20/2016
❑ Compliant— Certificate of Compliance � Noncompliant— Notice of Noncompliance
(Valid for 3 years from report date, unless shorter fime (See Upgrade Requirements on page 3.)
frame ouflined in Local Ordinance.)
Reason�sj for noncompliance(check all applicable)
❑ Impact on Public Health(Compliance Component#1)—Imminent threat to public health and safety
❑Other Compliance Conditions(Comptiance Component#3)—Imminenf threat to public health and safety
�Tank Integrity(Compliance Componenf#2)—Failing to protect groundwater
❑Other Compliance Conditions(Compliance Component#3)—Failing to protect groundwater
� Soil Separation(Compliance Componenf#4)—Failing to protect groundwarer
❑Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant
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Property Information �i����7�� Par�ei i�#or se�rrwPiRan9e: __
Property address: 4380 Co ` ac�6 Long Lake MN Reason for inspection: Property Transfer
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Property owner: Bank Owned Owner's phone:
or
Owner's representative: Dan Moore Representative phone: 763-232-6990
Local regulatory authority: City of Long Lake Regutatory authority phone:
Brief system description: Tank has no bottom. Redox at 18"
Comments or recommendations:
Mound system needed.
Certification
1 hereby certify that al!the necessary information has been gathered to determine the compfiance sfafus of this system. No
determination of future system performance has been nor can be made due to unknown conditions dunng system construction,
possib/e abuse of the system, inadequate maintenance, or future water usage.
Inspector name: Chad Lashinski Certification number: C3054
Business name: Residential Testi � s License number: L3636
Inspector signature: Phone number: 612-991-7044
Necessary or locatly Required Attachments
� Soil boring logs � SystemlAs-built drawing ❑ Forms per local ordinance
� Other information(list): Additional Terms _
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in atternative formats
wa-wwrsts4-31 • 3/16/11 Page 1 of 3
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Property address: 4380 County Road 6 Long Lake MN inspector initials/Date: I
(n►m/dtVYYYY) �
1. Impact on Public Health—Compliance component#1 of 5
Com liance criteria• Verification method(s):
System discharges sewage to the ❑Yes � No �Searched for surFace outlet
round surFace. �Searched for seeping in yard/backup in home
System discharges sewage to drain ❑Yes �No ❑Excessive ponding in soil systeMD-boxes
tile or surfac�e waters. ❑ Homeowner testimony(See CommentslExpJanation)
System causes sewage backup into ❑Yes � No ❑"Biadc soil"above soil dispersal system
dweiling or establishment.
❑System requires"emergency"pumping
Any"yes"answer above indicates the ❑Performed dye test
system is an imminent threat to public ❑ Unable to verity(See Comments/Exp►anation)
healfh and safety. ❑pther methods not listed(See Comments/Explanation)
Comments/Explanation:
2. Tank Integrity—Compliance component#2 of 5
Com liance criteria: Verification method(s):
System consists of a seepage pit, ❑Yes �No �Probed ta�k(s)bottom
cesspool,drywe{I,or leaching pit. �Examined�nstnaction records
Seepage pirs rr►eeting 7080.2550 may be ❑Examined Tank Integrity Form(Attach)
«�m liant if apowed in local ordinance.
❑Observed liquid level below operating depth
Sewage tank(s)leak below their ❑Yes � No
designed operating depth. ❑ Examined empty(pumped)tanks(s)
If yes,which sewage tank(s)leaks: ❑Probed outside tank(s)for"black soil"
Any`�es"answer above in�cates the ❑ Unable to verify(See CommentsiExplanation)
system is failing to protect groundwrater. ❑aher methods not listed(See CommentslExplanation)
Com m enta/Explanation:
3. Other Compliance Conditions—comp�iance component#3 of 5
a. Maintenance hole c�vers a�e damaged,cradced,unsecxu�,or appear to be structurally unsound. ❑Yes' �No p Unknown
b. Other issues(ele�recal hazards,etc.)to immediately and adversely impad public heaRh or safety. p Yes' �No p Unknown
*Sysfem is an imminent threat to puWic heslth and safety.
Explain:
c. System is non-protective of ground water for other condfions as detertnined by in�pedor. p Yes• �No
*System is failing to protect groundwater.
Explain:
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800•657-3864 • Available in altemative formats
wq-wwists4-31 • 3/16/12 Page 2 of 3
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Property address: 4380 County Road 6 Lonq Lake,MN Inspector initials/Date: I
(n►i►✓dd/YYYY)
4. Soil Separation—Compliance component#4 of 5
Date of instalfation: �Unknown Verification method(s):
��"���� Soil observation does not expire.Previous soil
ShorelandlWa�lhead protecdontFood beverege �Yes �No observations by two independent padies are sufi'icient,
lodging? unless site conditions have been a/tered or local
Com liance Criteria: �quirements differ.
For systems built prior to Aprii 1, 1996,and ❑Yes � No �Conducted soil observation(s)(Attach borirrg logs)
not located in Shoreland or Wellhead ❑Two previous verifications(Attech boring�ogs)
Piotection Aiea or nof seiving a food,
beverage or lodging establishment: ❑ Not applicable(Holding tank(s),no drai�eld)
Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Exptanation)
separation distance from periodically ❑Other(See Comments/E,cplanatbn)
saturated soil or bedrock.
Non performance systems built April 1, ❑Yes ❑No Comments/Explanation:
1996,or later or for non-performance
systems loceted in Shoreland or Wellhead
Protection Areas orserving a food,
beverage,or lodging establishment.�
Drainfield has a three-foot vertical
separation distance from periodically
saturated soil or bedrodc*
Experrmental; "Other';or "Performance" ❑Yes ❑No Indicate de ths or elevations
systems 6uilt under pre-2008 Rules;Type!V
or V systems built under 2008 Rules(7080. A. Bottom of distribution media 24"
2350 or 7080.2400 (Advanced Inspedor
License required) B. Periodicall saturated soiUbedrock 18"
Drainfield meets the designed vertical C. S tem se aration 0
separation distance from periodically
saturated soil or bedrock. D. R uired com liance se aration" 24"
A/ly"no"answer above indicates the system is "May be reduced up to 15 percerrt if allowed by Local
failing to protect groundwater. Ordinance.
5. Operating Permit and Nitros�en BMP*—Compliance component#5 of 5 � Not applicable
Is the system operated under an Operating Permit? ❑Yes ❑No If"yea",A below is required
fs the system required to employ a Nitrogen BMP? ❑Yes ❑No If"yes",B below is required
BMP=Best Management Practice(s)specified in the system design
lf the answer to both questions is"no",this section do�s not need to be comp/eted.
Com liance criteria
a. Operating Permit number:
Haue the O rati Permit r uirements been met? ❑Yes ❑ No
b. Is the re uired nitro en BMP in lace and ro �i functionin ? ❑Yes ❑ No
Any"no"answer indicates Noncompliance.
Up�ade Requir�nents(Minn.Stat§t 15.55)An imminent threat to publ�health ar�d safety pTPHS)must be upgraded,repleced,or its use
discorrNnued within f�n months of roceipt of this rrotice or within a shorter period if req�ired by locel ortiinance.If the system is faifing tn protect
ground water,the system must be upgraded,replsced,or its use disconBnued within the time required by local ordinance.!f an exlsting system
is rrot failing as defrned 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,noMrithstandi»g any local adin�rrc:e that is mae strict This provrsron does not epply to systems in shor�land areas,
Wellhead Protection Areas,or those used in r.onnecfion with food,beverage,and bdging establishments as defined in law.
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats
wq-wwists4-31 • 3/16/i2 PoQe 3 of 3
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. Residential
Testing Solutions
MPCA#13636
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16739 Ward Lake Drive NW,Andover,MN 55304
763.280.TEST info@RTSMN.com
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Residential Testin� Solutions, Inc.
Additional Terms
1. Reaidential Teating Solutioas,Inc.(RTS)has not been retai.ned to warrant, guarantee or certify
the proper functioIL7IIg of the systema for any period of time beyond the date of inapection. Due
to the numerous factors(ueage,maintena.nce,tank pumping,soil characteriatics,previous fail- •
urea,etc.)which may affect the proper operation of a well or septic syatem, as well aa the inabil-
ity of R.TS to supervise or monitor the use of maintenance of the system or well,the report shall
not be construed as a warranty by RTS that the aystem/well will function properly for any par-
ticular period of time.
2. Minimum complianee inapection requirements relative to this inspection and this report include
on�y verification that the septie system has a water tight septic tank(s)and lift tank,the re-
quired separation from the bottom of the drainfieldimound distribution medium and saturated
soils,no back-upa of aewage into the dwelling and no diacharge of sewage%ffiuent onto the
ground surface or surface water. RTS dces not inspect basement ejector pumps or exterior]ift
tank pumps aa theq are considered to be a"maintenance item:' Sewage backup verification is
limited to observing the floor drain area and/or the information supplied by the last occupants
of the swelling prior to inspection. RTS cannot guazantee that the information given to it by
the last occupants of the dwelling is accurate. Some persons may attempt to hide or conceal
signs of previous back-ups.
3. Certification of this system does not warranty future use beyond the date of inepection. Any
system,old or new,can be hydraulically overloaded as a result of more people moving into the
house than were previously occupyiag it,improper mai.ntenance and/or heavy usage,tree roots,
freezing conditions,surface drainage problema,or the syetem can aimply stop working becsuse
of age. The average life expectancy of a properly maiatained septic syatem ia twenty to twenty-
five years.
4. A Compliance Inspection is not meant to be a test or inspection for longevity of the septie eys-
tem but rather is strictly for the purpose of determining if the septic sqatem is polluting the en-
vironment at the date and time the inapection is performed. This insgection is not intended to
determine if the septic aystem was originally deaigned or installed to past or present MP'CA or
local unit of governmeat code requirements.
5. WINTER.WORK. Client understands that inspections c�nducted during wi.nter weather are
more di�cult to perform because of paasible anow cover and/or ground frost. Septic syatem
components auch as tanks,tank covers,drop boxes,drop bog covers arnd soit treatment areas
are more difficult to locate in these c:onditions. Soild borings and drai.nfield locations are also
more difftcult to perform due to ground froat. RTS will attempt to use the same level of atan-
dards when performing winter work as when performing non-winter work however Client un-
deretands that due to the aforementioaed considerations,the same level of standards map not
be possible.
6. Client hereby agrees to indemnify,save and hold RTS,its agents and employees harmleas&om
any claims or causes of action,includi.ng attorney's feee, ariiaing from the performance of this
Contract by the R.TS or its agenta or employees.
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Client Date
Address� �f3�1? �t/l2 �? /�'T (� �H� L1�
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'� � `�` 7 ' • G " Street Address: Mailing Address:
�9�Esxp'4�� 2750 Kelley Parkway P.O. Boz 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 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 Identi d 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 recorrunends 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
�v -- 3 r��i . The tank(s) should be cleaned through the manhole and
not tluough the inspection pipes, this allows for proper cleaning.
Comments:
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n ector: P ` - Date of Ins ection "C��
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'�'elephone(9�?)249-460t3 � �ax(9�?) 2�9-�61�
w�rvw.ci.mrono.mn.us
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�.,,;�� •�;�',�G Street Addresr. �lSe'?�-�49-y6o O Mailiag A�reas•
��q'�' 2750 Kelley Parkway P.O. 8ox 66
Orono, MN 55356 G�rstal �ay, NN 55323-0066
To Current Owner: Address: �3�6 ,�',�}'� ���- N'�
City Ordinance i99 requires that each existing on-site sewage treatm�t system in Orono be inspected every two years.
The on-site sewage treatment system at the above address has been inspected and appears to fa11 into the categories checked below.
SYSTEM CONFORMITY (1-3): 3
_.,,.__-.- . .._ —.
1 "CODE SYSTEM"An ISTS which meets all the location,design and construi:tion stancLrds of the curre�nt Orono Municipel Code.
2 "COMPLIANT SYSTEM" An LSTS which does not meet all the locatiaa,design aud construction standards of the current Orono
Municipal Code but does meet d�e fluce foot separation requirement or two fioot requir�►ent for systems installed 1996 or earlia,and
wbich is not failing or an i�►in�t ihreat to public health or safety.
�j`NON-COMPLIANI'SYSTEM" A prolu�birsa iS1s;an ISTs located wirlvn a aesi�atea 1 oo-year aooa plain,any LSTs which may
or may not meet all the location,design,or construction staac�rds of the current Orono Municipal Code and which is failing for any
reason;and any IST'S with less than t�ree feet of unsaUu�eted soil or sand between the distn'bution device and the limiting soil charactexistics.
TANK CONDTTION(5-71:
Tank inspection indicates:
5 P�npout not needed at this time.
6 Septic tanks must be pumped out this year (city code recommends tanks to be pumped out once every 3 yeazs.
Tank was�ast pumped, )•
Make sure seatic�tanks sre�nmced thronsh manhole and aot throa¢h white insuection uiaes. Tbis sllows for the arouer
cleanin¢ Keea water soi�er and iron Slter discharge out of seatic svstem to arolona life�f drainfield Ask uamner to test
alarm float to verifv alarm is still workioP ia vour house The alarm warns owaer that sent�e is about to backua iato bssement
7 Inspection risers missing-tanks could not be inspacted. Tx►spection risers{4°dia-piPe)must be installed in each tank. If
tanks have not been ptimped out within�e last three years,they should be pumped out now.
D IELD CONDITION 8-10 : �s
8 Drainfieid is dry,no surfacing evident.
Some evidence of surfacing,not critical yet.
10 Drainfield is saturated and visibly discharging untreated ef�luent to the surface. Contact the City Inspector
immediately.Repairs must be completed within 9U days.
COMMENTS: ������-:�,\J �� ��,.,_ t o c-�p�;�,.�- �-- - r.v� �� lt���c�'
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Date of Inspxtion Matt Bolterman- Septic System Inspector
Note: In the event that d►is inspa�ion report is used W satisfy the reqnir�eats for a mortgage or otha t�snsfer of property,be advised that this ceport does
not guarantee or cudfy thst an existing system will continue to function ProPerly, but is me�elY an opinion of the a�quacy af tbe system anda current
conditions based on 13�e available aufrnmation.
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CITY OF ORONO � O�
Municipal Offices O O
Post Office Box 66 -
Crystal Bay, MN 55323-0066 � � ON—SITE SEWA(�E TREATNIF,�1T
r�,, �, INSPECTION REPORT
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Owner: �14/7LQ,1� �14/ZY�IT]�R Address: /.�r7U v��/'� TI✓�N. ( ��JcSl4�
Permit �'s: �' Dates: �� Contractors:
City ordinance nunber 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 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 which 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
between the distribution device and the limiting soil characteristics.
(The limiting soil characteristic�has or ( ] has not been identified at this time. 1f the limiting soil
characteristic has not been ident'ifieZ��, this classification may be subject to revision.)
TANK CONDITION (5-10):
Tank inspection indicates:
Punpout not needed at this time.
6 Solids accumulation in tanks indicates they should be punped out this year to help prevent future problems.
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 punped out within 48 hours to eliminate surface discharye.
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 pumped out within the last three years, they should be punped
out now.
10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
If tanks have not been punped out within the last three years, they should be punped out now.
DRAINfIELD CONDITION (11-14):
Dreinfield inspection indicates:
11 Oreinfield is dry, no surfacing evident.
12 Some evidence of surfacing, not critical yet.
13 Dreinfietd is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately. Repeirs must be completed within 90 days.
14 Drainfield extent and condition unknown.
LIMITING S1TE FACTORS (sloce.setbacks.etc.): �Q,-I-EIL--r-f4-R��y
POTENTIAL FOR SYSTEM FAILURE Cdecends on soils.water table,etc.): ��«�,
COMMENTS: ` \
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Date of Inspection eptic ystem 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 will continue to function
properly� but is merely an op�nion of the adequacy of the system under current conditions based on the available
tnformatton.
This report must be kept on the pre�nises with the system locstion and punping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
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�,��:;�;`., � CITY of ORONO
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.�9! ,-�\7^�,.,�¢.� SVeet Address: MailinQ Address:
�'F,+ggO 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: �C.?,-'°�. �� �U/ ' �--�� Address:43 80 Sixth Ave. N.
Permit #'s:none Dates: Contractors:unknown
(This is � an existing system [ ] new construction)
SYSTEM COMPLIANCE (1-3) : 3
1 Code Svstem,: Meets or exceeds current City standards in all respects relating to
design, construction, and location. Appears to be operating properly.
2 Compliant Svstem: 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.
� Non-Compliant Svstem: System may or may not meet current City standards for design,
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 �] has or ( � has not been identified at this time. If the
saturated soil level has n t been identified, this classification is subject to revision.)
TANK CONDITION (5-9) : 6
5 Pumpout not needed at this time
� Solids accumulation in tanks indicates they should be pumped out this year.
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.
9 Inspection pipe is located over tank baffle-can not measure solids accumulation. If
tanks have not been pumped out within three years, they should be pumped out now.
(During the last septic tank Maintenance Pumpout the tanks [ ] were or [� were not
confirmed to be watertight by the licenaed pumping contractor. If the tanks were not
confirmed to be watertight, thia classification is subject to reviaion.)
DRAINFIELD CONDITION (11-14) : 14
11 Drainfield is dry, no surfacing evident.
12 Some evidence df surfacing, not critical yet. Repair is not required at this time.
13 Drainfield is saturated and visibly discharging 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: (svstem aae and condition, soils, etc. ) : medium
CONIl�IENTS: The non-compliant aeptic system muat be repaired by 12/31/2006 or within 90 days
of failure (aurface discharge) , whichever comes first.
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Date of Inspection p c System Inspector
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 Box 66
Crystal Bay, MN 55323-0066 � � ON—SITE SEWA(;E TREATNIENT
r� � INSPECTION REPORT
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Owner: � lL�'rl1L�� �L]�,�YlTiC1� Address: ``t�� �rX�i/P, /�V+��
Permit #'s: �I1� Dates: '� Contractors:_U��b�uY�
City ordinance nurtil�er 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 below.
(This is �L an existing system [ ] neu construction)
SYSTEM CONFORM[TY (1-3):
1 "CODE SYSTEM"-A system which meets all the tocation, 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.
"CONFORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the
current City Codes, but uas 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
between the distribution device and the limiting soil characteristics.
(7he limiting soil characteristic [ ] has or 'p(1�has not been identified at this time. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDITION C5-10):
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Tanks should be pumped out as soon as possible.
$� System is discharging to the surface. Tanks must be punped out within 48 hours to eliminate surface dischar�e.
� Inspection risers missing-tanks coutd not be inspected. Ins e ' ' " ' �st be installed in each
tank at next ��t• If tanks have not been pu out within the ast hree years,
out now.
10 Inspec io"f n pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation>.
If tanks have not been punped out within the last three years, they should be pumped out now.
DRAINFIEID CONDITION C17-74):
Drainfield inspection indicates:
11 Drainfield is dry, no surfacing evident.
12 Some evidence of surfacing, not critical yet.
73 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately. Repairs must be completed Within 90 days.
10 Drainfield extent and condition unknown.
LIMITING SITE FACTORS Csloae,setbacks,etc.):
POTENTIAL FOR SYSTEM FAILURE (deaends on soils,water table,etc.):
COMM NTS: /�' 'J!�Q ���I�T �/� Y1S��D 11'I'�pPC� ��Z����jb�/Krl b�4���M'��1
-,-r-
Date of Inspection S tic S s em Inspector
Note: In the event that this inspection report is used to satisfy the requirert�nts 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
properlyi 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 tocstion and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
On the North Shore of
Lake A�Iinnetonka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
1335 S. Brown Rd.
� � � Crystal Bay,MN 55323
473-7357
OWNER /��r � ��� ADDRESS ���_S1I`TlL�V� �
PERMIT NO.'S. y�e DATES � CONTRACTORS
City Ordinance No. 210 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.The onsite sewage
treatment system at the above add►ess has been inspected and appears to fall into the category checked below.
(This is �an existing system ❑ new construction)
� � Meets or exceeds current City standards in all respecta relating to design,construction,and location.Appears to be operating
properly.
�71 2 Does not meet all current City standards for new construction (1978 Code) but in most respects appears to be designed,
�j�� located, and constructed generally in accordance with p�evious codes.System appears to be functioning properiy;no major
upgrading of the system is required at this time.
� 3 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.
n 4 System may or may not meet current City standards for design,co�struction or location,but is failing 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
creating a safety hazard,or is otherwise creating a public nuisance.Please contact the City Inspector to discuss system repair/
replacement procedures. If drainfield replacement is necessary,soil testing will usuatly be required,and a design and site plan
must be submitted for review.Your contractor must obtain a permit before work is started.
SYSTEM CONDITION ( m Checked items may require your action)
Tank inspection indicates: ❑ Inspection pipe is located directly over tank baffle.(Does not
❑ Pumpout not needed at this time, give accurate measurement of solids accumulation.) If tanks
❑ Solids aacumulation in tanks indicates they should be pump- have not been pumped out within the last three years,they
ed out this year to help prevent future problems, should be pumped out now.
O Solids accumulation in tanks is at a critical level. Tanks Drainfield inapection indicetes:
should be pumped out as soon es possible. ❑ Orainfield is dry,no surfacing evident.
❑ System is discharging to surface. Tanks must be pumped ❑ Some evidence of surfacing,not critical yet.
within 48 hours to eliminate surface discharge. ❑ Drainfield is saturated and visibly discharging untreated
�Inspection risera missin —tanks could not be inspected, effluent to the surface. This condition may require replace-
nspec�on nsera ia.pipe)must be installe m eac tan ment or additions to drainfield. Contact the City Inspector
at next pumoout If ta _� immediately.Repairs must be completed within 90 days.
the laat three years,they should be pumped out now. �.Drainfield extent and condition unknown.
SITE CHARACTERISTICS:
Limiting Site Factors Potential for System Failure Site Capabilities for
❑ Slope (depends on soit types,water Future Expansion
❑ Soil table,and system condition) ❑Adequate
❑ High water table Low ❑ Fair
❑ Lot size �-Medium �-Poor
❑ Lake,wetla�d,or stream ❑ High ❑ Inadequate
❑ Drainage ❑System is causing visible
surf discharge.
COMMENTS: Y S I�U l
/�`
Date of Inspection eptic System Inspector
Note: In the event that this i�spection report is used to satisfy the requireme�ts 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 information.
This report must be kept on the premises with system location and pumping records.
WHITE COPY/Inspector's File `GOLD COPY/Homeowner