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HomeMy WebLinkAbout10-28-2021 Septic ComplianceMINNESOTA POLLUTION Compliance inspection report form CONTROL AGENCY p F' 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) St. Paul, MN 55155-4194 Loc Type: Compliance and Enforcement Instructions: Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final determination of compliance or noncompliance. Instructions for filling out this form are located on the Minnesota Pollution Control Agency (MPCA) website at https://www,pca.state,mn.us/sites/default/files/wg-wwists4-31a.pdf. Property information Local tracking number: Parcel ID# or SecfTwp/Range: 3311823440039 Reason for Inspection Propery Transfer Local regulatory authority info: City Property address: 2675 Fox Street Owner/representative: Victoria Ter of Orono Owner's phone: 612-730-1081 Brief system description: Approximately 2 -1000 -gallon septic tanks, 1 -1000 -gallon lift station and 410 square feet of mound rock bed. System status System status on date (mm/dd/yyyy): 10/28/2021 ® Compliant—Certificate of compliance* (Valid for 3 years from report date unless evidence of an imminent threat to public health or safety requiring removal and abatement under section 145A. 04, subdivision 8 is discovered or a shorter time frame exists in Local Ordinance.) ❑ Noncompliant— Notice of noncompliance Systems failing to protect ground water must be upgraded, replaced, or use discontinued within the time required by local ordinance. An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt *Note: Compliance indicates conformance with Minn.. of this notice or within a shorter period if required by local ordinance or R. 7080.1500 as of system status date above and does not under section 145A.04 subdivision 8. guarantee future performance. Reason(s) for noncompliance (check all applicable) ❑ Impact on public health (Compliance component #1) — Imminent threat to public health and safety ❑ Tank integrity (Compliance component #2) — Failing to protect groundwater ❑ Other Compliance Conditions (Compliance component #3) — Imminent threat to public health and safety ❑ Other Compliance Conditions (Compliance component #3) — Failing to protect groundwater ❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) — Failing to protect groundwater ❑ Soil separation (Compliance component #5) — Failing to protect groundwater ❑ Operating permit/monitoring plan requirements (Compliance component #4) — Noncompliant- local ordinance applies Comments or recommendations There is 1.5 feet of sand under the rock bed. TBM: Top of the Southeast property corner iron. ELV.-100.0 Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. 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. By typing my name below, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this form. Business name: Rusty Olson Soil & percolation Testing Certification number: C1255 Inspector signature: Joseph J. Olson License number: L810 (This document has been electronically signed) Phone: 763-498-8779 Necessary or locally required supporting documentation (must be attached) Z Soil observation logs System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit ❑ Other information (list): https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-32b • 4/28/2021 Page 1 of 4 Property Address: 2675 Fox Street Business Name: Rusty Olson Soil & percolation Testing Date: 110/28/2021 1. Impact an public health — Compliance component #1 of 5 iance criteria: System discharges sewage to the ❑ Yes, ONO ground surface discharges sewage to drain I ❑ Yes* Z No System causes sewage backup into ❑ Yes* ® No dwelling or establishment. Any "yes" answer above indicates the system is an imminent threat to public health and safety. Describe verification methods and results: Visual. Nothing was found Attached supporting documentation: ❑ Other: _ M Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes* ®No cesspool, drywell, leaching pit, or other pit? Sewage tank(s) leak below their [:]Yes* 0 No designed operating depth? If yes, which sewage tanks leaks: Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Albin's Septic Pumping pumped the tanks. Attached supporting documentation: ❑ Empty tank(s) viewed by inspector Name of maintenance business: License number of maintenance business: Date of maintenance: ® Existing tank integrity assessment (Attach) Date of maintenance 10/2/2021 (mm/ddlyyyy): (must be within three years) (See form instructions to ensure assessment complies with Minn. R. 7082.0700 subp. 4 8 (1)) ❑ Tank is Noncompliant (pumping not necessary - explain below) ❑ Other: https://www.pca.state.mn.us 651-296-6300 800-657-3864 • Use your preferred relay service Available in alternative formats wq-wwist54-31b • 4/28/2021 Page 2 of 4 Property Address: 2675 Fox Street Business Name: Rusty Olson Soil & percolation Testing Date: 10/28/2021 3. Other compliance conditions — Compliance component #3 of 5 3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? ❑ Yes' ® No ❑ Unknown 3b, Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? ❑ Yes' 2 No ❑ Unknown *Yes to 3a or 3b - System is an imminent threat to public health and safety. 3c. System is non -protective of ground water for other conditions as determined by inspector? ❑ Yes* 0 No 3d. System not abandoned in accordance with Minn. R. 7080.2500? ❑ Yes' ® No *Yes to 3c or 3d - System is failing to protect groundwater. Describe verification methods and results: Visual. Nothing was found Attached supporting documentation: ® Not applicable ❑ 4. Operating permit and nitrogen BMP* —Compliance component #4 of 5 ❑ Not applicable Is the system operated under an Operating Permit? ❑ Yes ❑ No If "yes", A below is required is the system required to employ a Nitrogen BMP specified in the system design? ❑ Yes ❑ No If "yes", B below is required BMP = Best Management Practice(s) specified in the system design If the answer to both questions is "no". this section does not need to be completed. Compliance criteria: a. Have the operating permit requirements been met? ❑ Yes ❑ No b. Is the required nitrogen BMP in place and properly functioning? ❑ Yes ❑ No Any "no" answer indicates noncompliance. Describe verification methods and results: Attached supporting documentation: ❑ Operating permit (Attach) ❑ https://www,pca.state.mn.Us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwisfs4-31b • 412812021 Poge 3 of 4 Property Address: 2675 Fox Street Business Name: Rusty Olson Soil & percolation Testing Date: 10128/2021 5. Soil separation — Compliance component #5 of 5 Date of installation 10/20/2011 (mm/ddlyyyy) ShorelandlWellhead protection/Food beverage lodging? Aiance criteria (select one 5a. For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment. Drainfield has at least a two -foot vertical separation distance from periodically saturated soil or bedrock. 5b. Non-performance systems built April 1, 1996, or later or for non- performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment. Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* 5c. "Experimental', "Other", or 'Performance" systems built under pre -2008 Rules; Type IV or V systems built under 2008 Rules 7080. 2350 or 7080.2400 (Intermediate Inspector License required 5 2,500 gallons per day; Advanced Inspector License required > 2,500 gallons per day) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. ❑ Unknown ® Yes ❑ No Yes [:]No* Attached supporting documentation: ® Soil observation logs completed for the report ❑ Two previous verifications of required vertical separation ❑ Not applicable (No soil treatment area) ® Yes ❑ No* Indicate depths or elevations ❑ Yes ❑ No* *Any "no" answer above indicates the system is falling to protect groundwater. Describe verification methods and results: A. Bottom of distribution media 100.9 B. Periodically saturated soil/bedrock 97.9 C. System separation 3.0 D. Required compliance separation* 2.55 *May be reduced up to 15 percent if allowed by Local Ordinance. Upgrade requirements: (Minn. Stat. § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. https://www.pca.state.mn.us 651-236-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 4 of 4 2021 SEPTIC MAINTENANCE REPORT Site address: 2675 Fax St ( Victoria Terry ) Dumber of tanks:_ 3 Date last pumped: 10/02/2021 Gallons pumped:, 2100 Name of pumper / maintenance provider: Are tanks watertight?: Albin's Septic Pumping, LLC YES NO (please circle one) Is the system functioning properly? Yes ('re slow drainage, wetness in the drainfield?) Do you have any specific concerns or issues that you'd like to discuss with the SSTS Program Manager? No if so, please indicate best time and telephone number(s) to be reached between B am and 4:30 pm. Best Times Alicia Johnson CITY OF ORONO PO BOX 66 CRYSTAL BAY MN Telephone Nurnber(s) RETURN IN THE ENCLOSED ENVELOPE AS SOON AS POSSIBLE 55323-0066 MINNESOTA POLLUTION Sewage tank CONTROL AGENCY 520Lafaymelt)WNorth maintenance reporting form St. Paul, MN 55155-4194 Irl, bsurfacO $OWtis! TrOatltl3mnt Systems ($ST$) Program Purpose: Management and maintenance of Subsurface Sewage Treatment Systems (SSTS) are important to ensure resource protection and long-term and cost-effective sewage treatment. Completion of this form complies with the sewage tank maintenance requirements under Minn. R. 7080,2450 and 7082.0600. This form may be used to certify the compli nce t8 tus ofthe may sewa aomporoft of the SSTS. This form is not a complete 55TS inspection report, only a tank Integrity only cersf)1 sewage tank compliance status when entirely completed and signed on page 3 by a qualified professional. Irtstructlons: A Dopy of this hkwmadon must be subm ttsd to the system owner within 30 days of the maintenance date and be maintained by the k wmad SSTS maintainer business for a period of five (5) years from the maintenance date. Malnilertiance reporting W lite kx:el unit of gmemmmt may be required by local ordinance. Check with your local SSTS program for maintenance reporting protocol. Secure maintenance hole covers All maintenance hole covers must be returned to service in a sound and durable condition and be capable of withstanding the anticipated load. Covers must be re -secured in accordance with Minn. R. 7080.2450, subp. 3, Items C or D: ary 4, 2008 must be locked, bolted or screwed or must be 95 a) Covers Installed under local ordinances adopted after Febru pounds in weight They must be made of material suitable for outdoor use, resistant to ultraviolet degradation and lurks, and not susceptible to being slid or flipped. They must have a label waming of hazardous conditions inside the tank. All screw openings must be refastened. b) Covers installed under local ordinances adopted before February 4, 2008 must eitherbe buried with at least 12 inches of sail cover or be secured according to the local ordinance in effect before February 4, 2 008. C) Covers must most Item `a' above when raised to the ground surface or less than 12 inches from the ground surface. Reporting information 10102!20 1 Reason &Com tierce Ins tion Date of maintenance (rnmlddlyyyy) ..,._. 003_ Patel #p: 041172343 _ Property address: 2675 Fox St zip code: 55,391 cW. ©rono _ state: MN _.. _ . Property owner's ,tame: Victoria Ter Property -owner's address if different - State. — — - dip code: _ _ — Phone number: 612-730-1081 Email address: victoriategyj ft_msn c orn 1. Did you measure the accumulation of scum and sludge? ❑ Yes ($ No (tank(s) pumped without measuring) _Tank (check if praseny -- Scum Slud$e OPera die nth Percent full — _JELS9.�clholdjng tank #1 - _RSeptirJholding tknk #2 —. - - — — — -- — — — .Q Pretreatment tank — 2. Access used to remove septage: Maintenance holes 0 Other (Unless a holding tank, go to #4 below) 3. If the maintenance hole was used, were all covers secured in place? ji Yes ©No If no, please explain below: 4. if the oyster refuses to allow a Subsurface Sewage Treatment System (SSTS) to be pumped through the maintenance hole, have them complete and sign the following statement - 1., refuse to allow the removal of the solids and liquids through the maintenance (Print aWiw name) hole. I understand that removal of solids and liquids through other access points is not considered a compliant method o solids removal and does not fulfill the solids removal requirements of Minn. R. 7080.2450 and 7082.0600. By W#ngisigsing my name below, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this form. Owner's signature: _. Date (mmlddhryyy): A WWW.pca.st3te.mn.us •— 651-296 63ai 800-657-3864 Use your preferred relay service n Available in altemitive formats Page Y of 3 wq_wwists4_38 • lAof21 M:�.`, MINNESOTA POLLUTION Sewage tank : CONTROL AGENCY 520 LafayeM Road North maintenance reporting form St. Paul, MN 55155-4194 Subsurface SeW&W Treatment Systems (SETS) Progr&m Management and maintenance of Subsurface Sewage Treatment Systems (SSTS) are important to ensure nesovrce purpose: tank maintenartc4 protection and long-term and cost-effective sewage treatment. Completion of this form complies with the sewage requirements under Minn, R. 7080.2450 and 7082.0600. This form may be used to certify the compharme��mtus of he sewage ay tank components of the SSTS. This form Is not a COmptete SSTS inspection report, only a tank integrity usslified rofer3sional. only certify sewage tank compilanca status when entirely completed and signed on pageby 4 p Instructions: A copy of this hfcmw ion must be submitted to the system owner within 30 days of the maintenance date and be maintained by the kwmW SSTS maintainer business for a period of five (5) years from the maintenance date. Maintenance reporting to the local unit of governmeit may be required by local ordinance. Check with your local SSTS program for maintenance reporting protocol. Secure maintenance hole covers All maintenance hole covers must be returned to service in a sound and durable condition and be capable of withstanding the anticipated load. Covers must be re -secured in accordance with Minn. R. 7080.2450. subp. 3, Items C or D: a) Covers Installed under local ordinances adopted after February 4, 2008 must be locked, bolted or screwed or roust be 95 pounds in weight. They must be made of material suitable for outdoor use, resistant to ultraviolet degradation and leaks, and not susceptible to being slid or flipped. They must have a label warning of hazardous conditions Inside the tank. All screw openings must be refastened. b) Covers installed under local ordinances adopted before February 4, 2008 must either be buried with at least 12 inches of soil cover or be secured according to the local ordinance in effect before February 4, 2008. c) Covers must meet item 'a' above when raised to the ground surface or fess than 12 inches from the ground surface. Reporting information Date of malntensnce (mmldtiryyyy): 10102/2021 — Reason for maintenance: Maintenance & Compliance Ins tion Property address: 2575 Fox St _ _ _ _ Parcel ID. 04117234300Q3--- City Orono _ _ _ State: .MN -- _ zip code: 55391 Property ownses name: VictoriaTerry Property.,owner's address if i1ft ent - State:- ` zip Vie: - — —� — Phone number. 612-730-1 Email address: victoriaterryl Ca msn com -- 1. Did you measure the accumulation of scram and sludge? © Yes No (tank(s) pumped without measuring) Tank (check 4 pnwentj -- Scum Sludge _ Operating pth _ Percent full — IglhoI incl tank #1— �Septkhtoidingtank.#2— Q Pretreatment tank— _RPumP—t-ank- 2 Access used to remove septsgs: ${ Maintenance holes[] other (Unless a holding tank, go to #4 below) 3. If the maintenance hole was used, were all covers secured in place? 0 Yes j] No If no, please explain Wow: 4. If tate owner refuses to allow a Subsurface Sewage Treatment System (SSTS) to be pumped through the malntenance hole, have them complete and sign the following statement refuse to allow ttte removal of the solids and liquids through the maintenance (Pow ownar'a name) hole. I understand that removal of solids and liquids through other access points is not considered a compliant method of solids removal and does not fulfill the solids removal requirements of Minn. R. 7080-2450 and 7082.0600. By W#nglsfgnirref my name below, i certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this form. Owner's signature: _ -, _ .. Date (mmldd/yyyy): use your preferred relay service — Available in akernatW formats www.pca.state.rnn.us 651-296.6300 800-657-3864 page 3 of 3 w¢1Nwjsts4-38 ■ IP121 Property address: 2675 Fox St _ Parcel ID: State: 04117234.30043 city` _rono MN Zip code: 55391 _ } . • . _ . — - - - ti. Is the tank designed as a leaky tank? (Example: seepage pit cesspool, drywell, leaching pity Tank #1: ❑ Yes ❑ No Verification method used: Tank #2: ❑ Yes ❑ No Verification method used: _.._ 6. Is there evidence of the following? Tank [chock ifay!!!M§ .. _aSeptir1holdingTank #1 ho41ng Tank #2 �_retrea meat Tank Pump Tank _ Dencribe detail for any "Yes" Tank feake below the dealgn_ed operating depth 3 Yes $X No ❑ Yes �uNo ❑ Yes ❑ No. ❑ Yes E9 Maintwmmm Hole cover Is Tank leaks above the ; damaged, cracked, unsecured, or designed operationa.PPeam to bs structxraluriscsuund - Yes _l No + _ [1Yes R No, Yes �Nor7l Yes 19 No No 171 Yes [:LNO ❑ Yes No t--- A- Yes ps_M No O _ r s 7. How many gallons of septage were removed? Tank #1. 1000 Tank #2; 1000 Pretreatment Tank: X _ Pump Tank- 100 $, Where was the septage taken? ® Wastewater treatment facility ❑ Land application ❑ Other Explanation (Facility name/Site #): _VVatertown, MflL—- 9. Did you identify any operational issues or unsafe conditions while assessing the sewage tanks In this system? l❑ Yes lel No if yes, identify tank and explain: ❑ Evidence of non-domestic waste ❑ Baffle(s) condition ❑ Effluent screen condition ❑ Maintenance hole and extensions condition ❑ other conditions (e.g. structural integrity of tank or lid, e1wrical hazard, etc.) Explanation: 10. List any troubleshooting and minor repalre completed or declined by owner. Troubleshooting and repairs conducted: _ _. ❑ Repairs declined b Replaced alarm float switch in the pump tank., Gleaned effluent filter wlalarm in 2nd tank outlet.' Additional comments or suggestions for owner's consideration: Pumping record 1 personally canduclbd firs work described above on behalf of a Minnosola-licensed SSTS Maintenance Business, in corruptions with Minnesota Rules Chapters 7080 - 7083: ❑ As a none ertified individual who has received proper training, daily work review, and periodic observation, or JR As a deaignated certified individual of the business listed below. By typin~g my dame below, I certify the above statements to be true and c onci, to the best of my knowledge, and that this infonmation can be used for the purpose of processing this form. Company information Company name: Albin's Septic Pumping, LLC Business license number: 334_6 Email: albinsseptic urn inJ�?ayahoo.com Employee's signature: www.pca.swe.mmus fi51-29fr63rat7 aw-07-38M w¢wwFsts4.38 ■ 1/7/21 Employee Information Print name: Peter Peterson . Certification number: (it apprr Nap 9227 T Phone number. 612-559-3456 Date (mmlddlyyyy);- 1Q/02/2021 ■ Use your preferred relay ser4im AvaVable in aftemative formats Page 2 of 3 Property address: 2575 Fox St _ . _ Parcel lo: 041172343f}Qfl3_ City: Orono --- _.. State: MN _ Zip rade: 55391. Optional section: Sewage Tank Compliance Certification (Tank integrity assessment) This form does not represent a complete system inspection report and only certifies sewage tank compliance statru& i.e., this form, completed, may serve as a tank integrity assessment. in ane: This section of the form may be completed and signed by a Designated Certified Individual (DCI) of a licensed SETS Maintenance Business who personally conducts the necessary procedures to assess the compliance status of each sewage tank in the system. When this section of the form is signed by a cluaiified cer#ifred professional, R becomes necessary supporting docu wntatdon to an Existing System Compliance Inspection Report: Cgmpliance inspegfin form - Existing system (wq "ists4-31.b], This form can be found on the MPCA website at https:/hwww.pca.state.mn.uslwaterlserAoe-and-maintenance. The information and certified statement on this form is required when existing septic tank compliance status is determined by an individual other than the SSTS Inspector that submits an inspection report. This fort represents a third party assessment of SSTS component compliance and is allowable under Minn. R. 7082.0700, subp. 4 Item (B) subitem (1). This form is valid for a period of three years beyond the signature date on this form unless a new evaluation is requested by the owner or owner's agent or is required according to local regulations. Additional Administrative Rule references for this activity can be found at Minn. R. 7082.0700, subp. 4 Items B, C, and 0; 7083.0730 Item C. Ig Certificate of sewage tank compliance Affirm all three statements: $) The SSTS does not contain a seepage pit cesspool, drywell, leaching pit, or other pit. ® It does not contain a sewage tank that was designed to be watertight, but subsequently leaks below the designed operating depth. ® It does not represent an imminent safety threat by reason of unsecured, damaged, or weak maintenance hole cover(s) or other unsafe condition. ❑ Notice of sewage tank non-compliance Select all that apply: ❑ The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit —'Failure to Proted Groundm ter." © It has a sewage tank that was designed to be watertight, but subsequently leaks below the designed operating depth -"Failure to Protect Groundwater." Q It presents a threat to public safety by reason of unsecured, damaged, or weak maintenance hole coven(s) or other unsafe condition -"Imminent Threat to Public Health or Safety." Company Inforfnaf on Designated Certified Individual (DCI) Information Company name: Albin's Septic Pumping, LLC______ print name: Peter Peterson Business license number. 3346 - --- Certification number 9227 1 pe►sonadly conducted the worts described above as a Designated Certified Individual of a Mtnnesota-Abotised SSTS Maintenance Business. / personally conducted the necessary procedures to assess the compliance status ofeach sewage tank its MIS SSTS. By typh*wgn ft my name below. I certify the above statements to be true and correct, J0 o Mq best of my lu fledge, and that this tr:tbmiation can be used /or the purpose of p 1ngl,th' 1100. Designated Certified Individual's signature: % " _ _._ _ _ Date (mmlddtyyyy): 10/02/2021 _ vuww.pp.state.me.us 651-196 6304 804657-3864 use your preferred relay service Available in alternative formats wq-wwists438 0 I/ml Page 3 of 3 Property Owner / project: Property Address / PID: Soil Observation Log www,ScpticResource.com vers 12.4 Victoria Terry 2675 Fox Street Owner Information Date 10/28/2021 Soil Survey Information ❑ refer to attached soil survey Parent matl's: 2 Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ organic ❑ Bedrock landscape position: ❑ Summit ❑ Shoulder 21 Side slope ❑ Toe slope soil survey map units: L3713 slope % direction- Lineal Soil Log #1 0 Boring ❑ pit Elevation 102.4 Depth to SHWT 54 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape loose loose single grain friable weak granular blocky 0-36 Mound sand Fill <35 firm moderate prismatic platy rigid strong massive 36-48 Loam <35 10yr3/1 Friable Strong Blocky 48-54 Clay Loam <35 10yr3/2 Friable Strong Blocky 54-60 Clay Loam <35 10yr4/3 10y4/8,1 -6/10y Firm Strong Blocky loose loose single grain <35 friable weak granular blocky 35-50 firm moderate prismatic platy >50 rigid strong massive Comments: TBM: Top of South East property corner iron Elv.- 100.0 . 2675 Fox Street Soil Log 42 CI Boring ❑ pit Elevation 102.4 Depth to SHWT 54 inches Depth (in) Texture fiaoment % matrix color redox color consistence grade shape loose loose single grain friable weak granular blocky 0-36 Mound sand Fill <35 firm moderate prismatic platy rigid strong massive 36-48 Loam <35 10yr301 Friable Strong Blocky 48-54 Clay Loam <35 10yr312 Friable Strong Block 54-60 Clay Loam <35 10yr413 10y418,1 -6110y Firm Strong Bieck% loose loose single grain <35 friable weak granular blocky 35-50 firm moderate prismatic platy >50 rigid strong massive 2675 Fox Street Soil Log #3 Lj Boring ❑ Pit Elevation Depth to SHWT Depth (in) Texture fragment % matrix color redox color consistence grade shape loose loose single grain <35 friable weak granular blocky 35-50 fmn moderate prismatic platy >50 rigid strong massive <35 loose loose single grain friable weak granular blocky 35 - 50 firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain friable weak granular blocky 35-50 firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain friable weak granular blocky 35-50 firm moderate prismatic platy >50 rigid strong massive loose loose single grain <35 friable weak granular blocky 35-50 firm moderate prismatic platy >50 rigid I strong massive I I hereby certify this work was completed in accordance with AM 7080 and any local reqs. Rusty Olson's Soil & Perc 810 signer Signature Company License # OVI-0 V1, 0 CITY OF INIMMCE (A0)%T' WORKSHEET FOR SEWAGE DISPOSAL. WORK Date / — zo - r t p_w Inspector + r V I + �� �� � � Building Permit No. Owner 1"5_ i_ld' v— _ _ Fee Property Address(0 +t f= 0 K in Building_ �._ Plumbing Contractor -Outside Sewage Disposal_. A4,e�, + Syn� Septic Tanks Material -- (,Mk �b6vwt�i'.')_Capacitias Proper Outlet & lnlet? I Baffle Plates? + Drain Field: Total length of lines plumber of lines Type of soil ���"'` Percolation Test C 21 Width of trench Type of filter material a='ec, Amount of filter material below line 1 2 1— Depth from top of the to finished grade q 1/2— Check %Check Vents ✓ Check Caulking I Check Oracle in Horizontal Waste Pipes ' Clean Outs Tonage or Yards of Filter Material Ise VATotal Sq. Footage of Drain Field y�w� SandJS­ Rock _f 0 y� Overall Size of Mound System Size of Mound System Rock Filter Material_`"' Draw detailed diagram to scale with measurements below. Z� 4 1-3, 1 - L( Lt? F l" � 4-e- v- I' VL (IUOAe VJ i a `A-eP" 2, "1 ,+4 t -Sr_ Baa c,1.4V2Vt, 4,3 0� E IN rn 4 01 -ri 0 x to �o