HomeMy WebLinkAbout2125 Carriage Lane - Septic ComplianceMINNESOTA POLLUTION Compliance inspection report form
CONTROL AGENCY
520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS)
St. Paul, MN 55155-4194 Doc 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/wq-wwists4-31a.odf.
Property information Local trackina number:
Parcel ID# or Sec/Twp/Range: 1011723240037 Reason for Inspection Property Transfer
Local regulatory authority info: City Of Orono, (952) 249-4600
Property address: 2125 Carriage Lane, Orono
Owner/representative: John Hull Owner's phone: 612-819-0106
Brief system description: 2-1300-gallon combination septic tanks, 1-1300-gallon lift station and 1254 square feet of gravelless pipe
system. Per County records.
System status
System status on date (mm/dd/yyyy): 12/11/2025
® 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.)
*Note: Compliance indicates conformance with Minn.
R. 7080.1500 as of system status date above and does not
guarantee future performance.
❑ 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
of this notice or within a shorter period if required by local ordinance or
under section 145A. 04 subdivision 8.
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
The system is designed for a five bedroom house.
The bottom of the lowest gravelless trecch is 1.5 feet below grade
The soils were verified on 09/10/2020
Included are the original and verification soil borings.
TBM: ground at lowest gravelless Trench. 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, / 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)
® 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-wwists4-31b • 412812021 Page 1 of 4
Property Address: 2125 Carriage Lane, Orono
Business Name: Rusty Olson Soil & percolation Testing Date: 12/11/2025
1. Impact on public health — Compliance component #1 of 5
Compliance criteria:
System discharges sewage to the ❑ Yes` ® No
ground surface
System discharges sewage to drain ❑ Yes ® No
the or surface waters.
System causes sewage backup into I ❑ Yes' ® No
dwelling or establishment.
Any "yes" answer above indicates the system is an
imminent threat to public health and safe_
Describe verification methods and results:
Visual. Nothing was found
Attached supporting documentation:
❑ Other:
® 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` ® No
designed operating depth?
If yes, which sewage tank(s) leaks_
Any "yes" answer above indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Kothrade Sewer,Water & Excavating 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 11/21/2025
(mm/dd/yyyy): (must be within three years)
(See form instructions to ensure assessment complies with
Minn. R. 7082.0700 subp. 4 B (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-wwists4-31b • 412812021 Page 2 of 4
Property Address: 2125 Carriage Lane, Orono
Business Name: Rusty Olson Soil & percolation Testing
3. Other compliance conditions — Compliance component #3 of 5
Date: 12/11/2025
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 ® 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* ® 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-wwists4-31b • 412812021 Page 3 of 4
Property Address: 2125 Carriage Lane, Orono
Business Name: Rusty Olson Soil & percolation Testing—
S. Soil separation — Compliance component #5 of 5
Date of installation 10/27/2000 ❑ Unknown
(mm/dd/yyyy) —
Date: 12/ 11 /2025
Shoreland/Wellhead protection/Food ® Yes ❑ No Attached supporting documentation:
beverage lodging?
❑ Soil observation logs completed for the report
Compliance criteria (select one):.-__ ® Two previous verifications of required vertical separation
5a. For systems built prior to April 1, 1996, and ❑Yes ElNo ❑Not applicable (No soil treatment area)
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.*
® Yes ❑ No* Indicate depths or elevations _
5c. "Experimental", "Other", or "Performance" ❑ Yes ❑ No
systems built under pre-2008 Rules;
Type IV or V systems built under 2008
Rules 7080. 2350 or 7080.2400
(Intermediate Inspector License required <_
2,500 gallons per day; Advanced Inspector
License required > 2,500 gallons per day) j
Drainfield meets the designed vertical
separation distance from periodically
saturated soil or bedrock.
*Any "no" answer above indicates the system is
failing to protect groundwater.
Describe verification methods and results:
A. Bottom of distribution media 1 98.5
B. Periodically saturated soil/bedrock 1.95.5
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 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats
wq-wwists4-31b 9 412812021 Page 4 of 4
��MINNESOTA POLLUTION
CONTROL AGENCY
520 Lafayette Road North
St. Paul, MN 55155-4194
Sewage tank
maintenance reporting form
Subsurface Sewage
Treatment Systems (SSTS) Program
Doc Type: Compliance and Enibrt;+ement
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 compliance status of the sewage tank
components of the SSTS. This form is not a complete SETS inspection report, only a tank integrity assessment, and may
only certify sewage tank compliance status when entirely completed and signed on page 3 by a qualified professional.
instructions: A copy of this information must be submitted to the system owner within 30 days of the maintenance date and be maintained
by the licensed SSTS maintainer business for a period of five (5) years from the maintenance date. Maintenance reporting to the local unit of
government may be required by local ordnance. Check with your local SSTS program for maintenance reporting protocol. Page 3 is
optional and not required to be completed on routine maintenance events.
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 must 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 less than 12 inches from the ground surface.
Reporting information
Date of maintenance (mm/ddyyyy): 11/21/2025 Reason for maintenance: Septic Compliance
Property address: 2125 Carriage Ln Parcel ID: 10-117-23-24-0037
City: Orono State: MN Zip code: 55391
Property owner's name: John S Leigh Nutl
Property -owners address (if different):
City: State. Zip code:
Phone number: 612-819-0106 Email address:
1. Did you measure the accumulation of scum and sludge? ❑ Yes )P4o (tank(s) pumped without measuring)
Tank check If resent
Scum
Sludge
Operating depth
Percent full
Se tielholdin tank #1
Se oidi tank #2
Pretreatment tank
❑ Pump tank
2. Access used to remove septage: �i Maintenance hole ❑ Other (Unless a holding tank, go to #4 below)
3. If the maintenance hole was used, were all covers secured in place? 46Yes ❑ No if no, please explain below:
4. If the owner refuses to allow a Subsurface Sewage Treatment System (SSTS) to be pumped through the maintenance
hole, have them complete and sign the following statement
i, (Part owners nerve) , refuse to allow the removal of the solids and liquids through the maintenance
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 AMN the solids removal requirements of Minn. R. 7080.2450 and 7082.0600.
By typf Ws4wfng 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 (mm/dd/yyyy):
www.pca.state.mn.us
wq-wwhts4-38 • 4/28pi
• 6Si-296.6300 a NO-657-3864 • Use your preferred relay service • Available in altemative formats
Page 1 of 3
Property address: 2125 Carriage Ln Parcel ID: 10-117 23-24-0037
City: Orono State: MN Zip code: 55391
S. is the tank designed as a leaky tank? (Example., seepage pit, c9opwi drywell, leaching pit)
Tank 411: ❑ Yes IFPNo Verification method used:
Tank #2: ❑ Yes ❑ No Verification method used:
6.
is uzere evraence oT une Torrowrng
Tank Ichack if resent
r
Tank teaks below the
designed operatina depth
Tank leaks above the
des) ned o radna depth
Maintenance hole cover is
damaged, cracked, unsecured, or
appears to be structurally unsound
Se tic/holdi Tank #1
0 Yes
No
Yes Jallo
0 Yes No
Septic/holdingSeptkftlding Tank #2
Yes
o
No
0 Yes
Yes KNo
No
0 Yes No
Yes No
Pretreatment Tank
Yes
El Pump Tank
0 Yes
QRNo
0 Yes &No
Yes No
Describe detail for any "Yes"
7. How many gallons of seepage were removed?
Tank #1: / 3 oo Tank #2: 1.104 Pretreatment Tank: Pump Tank: V ob
8. Where was the septage taken? F Wastewater treatment facility ❑ Land application ❑ Other
Explanation (Facility name/Site #). _ 1 der' *LVnI
9. Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system?
❑ Yes &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, electrical hazard, etc.)
Explanation:
10. List any troubleshooting and minor repairs completed or declined by owner.
and reDairs conducted:
Additional comments or suggestions for owner's consideration:
Pumping record
! perjonally conducted the work described above on behalf of a Minnesota -licensed SSTS Maintenance Business, in compliance
with Minnesota Rules Chapters 7080 — 7083:
❑ As a noncertified individual who has received proper training, daily work review, and periodic observation, or
® As a designated certified individual of the business listed below.
By typing/signing 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.
Company information
Company name: Kothrade Sewer, Water $ Excavating, Inc
Business license number. MPCA 192
Employee information
Print name: L.Bursch
Certification number: is spotc"y C9199
Email: —infoOkothrade.com a number. 763-498-8702
Employee's signature: Date (mm/dd/yyyy):
www.pca.state.mn.us • 651-2%-6300 • 800.657.3864 Use your preferred relay service • Available in alternative formats
wq-wwlsts4-38 • 4128/21 Pope 2 of 3
Property address: 2125 Carriage Ln Parcel ID: 10-117-23-24-0037
City: Orono State: MN Zip code: =91
Optional section: Sewage Tank Compliance Certification (Tank integrity assessment)
This form does not represent a complete system Inspection report and only certifies sewage Mink compliance status. i.e.,
this form, completed, may serve as a tank integrity assessment.
Instructions: This section of the form may be completed and signed by a Designated Certified individual (DCI) of a licensed SSTS
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 qualified certified professional, it becomes necessary supporting documentation to an
Existing System Compliance Inspection Report: Compliance ingggctign form - Existing system (wa-wwis1s431 b1. This form can be
found on the MPCA website at https:/hvww.pce.state.mn.ushvater/service-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 form 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
Owes 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 D; 7083.0730 Item C.
Pages 1 and 2 are not required to accompany this form when the optional third page is completed and used to certify
sewage tank compliance status.
System status
System status status on date (mm/dd/yyyy): 11 /21 12025
Certificate of sewage tank compliance ❑ Notice of sewage tank non-compliance
Compliance criteria:
The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit - "Failure to Protect ❑Yes* 0 No
Groundwater."
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect I [3Yes* �No
Groundwater."
The SSTS presents a threat to public safety by reason of structurally unsound (damaged, cracked, or ❑ Yes* Ja No
weak) maintenance hole cover(s) or lids or any other unsafe condition - "Imminent Threat to Public
Health or Safety."
Any "yes" answer above indicates sewage tank non-compliance.
Company information
Company name: Kothrade Sewer, Water S Excavating, Inc
Business license number: MPCA 192
Designated Certified Individual (DCQ information
Print name: L. Bursch
Certification number: C9199
I personally conducted the work described above as a Designated Certified individual of a Minnesota Jicensed SSTS Maintenance
Business. I personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS.
By typing/signing 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 processkIgrthis fonn.
Designated Certified Individuars signature: / Date (mm/dd/yyyy):
www.pca.state.mn.us
wq-wwistW-38 • 4128121
• 651-""3W 9 8WW7-3864 0 Use your preferred relay service 0 Available in alternative formats
Page 3 of 3
Property address: 2125 Carriage Lane, Orono _ inspector initials/Date: JS�_9/10/2020
_
(mmidd/yyyy)
4. Soil Separation — Compliance component #4 of 5
Date of installation: 10/27/2000 ❑ Unknown Verification method(s):
(mm/ddlyyyy) Soil observation does not expire. Previous soil
Shoreland/Wellhead protection/Food beverage ® Yes ❑ No observations by two independent parties are sufficient,
lodging?
Compliance criteria:
For systems built prior to April 1, 1996, and ❑ Yes ❑ No
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 j
separation distance from periodically
saturated soil or bedrock.
Non-performance systems built April 1, ® Yes ❑ No
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.*
'Experimental", "Other, or "Performance" ❑ Yes [--]No
systems built under pre-2008 Rules; Type /V
or V systems built under 2008 Rules (7080.
2350 or 7080.2400 (Advanced inspector
License required)
Drainfield meets the designed vertical
separation distance from periodically
saturated soil or bedrock.
Any "no" answer above indicates the system is
failing to protect groundwater.
unless site conditions have been altered or local
requirements differ.
® Conducted soil observation(s) (Attach boring togs)
❑ Two previous verifications (Attach boring logs)
❑ Not applicable (Holding tank(s), no drainfield)
❑ Unable to verify (See Comments/Explanation)
❑ Other (See Comments✓Explanation)
Comments/Explanation:
Boring:
1-12" 10yr 2/2 sandy loam
13- 55" 10 yr 4/4 sandy laom
No Redox
Indicate depths or elevations
16" fill may have
A, Bottom of distribution media _ been added ontop
i
B. Periodically saturated soil/bedrock 55"+
C. System separation 39"+
_D: __Regulred compliance separation' 36"
*May be reduced up to 15 percent if allowed by Local
Ordinance,
5. Operating Permit and Nitrogen BMP* — Compliance component #5 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? ❑ 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. Operating Permit number:
Have the Operating Permit requirements been mete [] Yes El No
b. Is the required nitrogen BMP in place and properly functioning?_— ❑Yes [] No
_ __...
Any "no" answer indicates Noncompliance.
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.
www.pca.state.mn.us 651-296-6300 800-657-3864 TTY 651-282.5332 or 800-657-3864 Available in alternative formats
wq-wwists4-31 • 3116112 Page 3 of 3
Westwood Pf nff "-.`;11)fl.
LOGS OF SOIL BORINGS
I Alf'll 1'r,Ulu(�1fJ '4•:
1 !+ t a
i•1 t�l*t M,)ity Orive, itc• a
Buffalo. MN .`i!i;i i a
1 AX. 617 Ge?
i A„ 11l,111 „1 P!,11, t I Itoll I'll I.I 1 ► \, 1„I', +, ,t
')N
I t,,l III:' tIIAtIt- It\ IZt)h `,\\ I ,'IC
I,I`.`,II It ,Ill+tll \\ .it'll) \,\1�I iI 1
I `i t \-ti1 ,
x ( 'III IIt'd
\lw I w,k-dithoA i\\u) ILind \
01 l'„\\tt
I Ii:'hl
a liu,ttt \ +I11h1
I ?t l,il; li,�lm. \umhrl _'. ���
la.,,,h �_
I4t,ri11:' :'�inul�t•! � S_
U, }
`�UIt.It.0 I Il�a,ltlli
II) �
�t1ltJtt' Ili\.III,+,I
�I
�1 y L ul rr
z i �.
I I
-
, _ <«
-
i
i Zc.�?
lt'�s i i•''i
-- -
1
L snn� lOr�
Vol Al
Sand] foam
t6Y,E 31cr
�C.n� /DYiQ
.31f
y _
--_
......
�.
{
I
It
i
I
f iitl Alt
�,.ultlnls+ \\.,Irl tahii
Alt
haul` alirf
t)tNIU:' llttiA`
i '
I.11d oI hof ill'
`t:illtlil)f' t\ Al"I 1 1!ttt'
i'It��.c•ni a! i��rl Ali ,1rIHh �
iT( I, .111i r h,>I II11'
t
I � '
TWestwood I'll (if( `;(Ilvl(f." III(
LOGS OF SOIL BORINGS t I ; BOO Anayl:tl„ I )I l „" I• t 10.1 M,Itty I )Ilve :At- :1
I titan Piame, MN t•t4 11111t.tltt MN `631 a
61,, 931 `,1',tl 1,1.'
r.•tl ite•,• i f92i11 (;H-j-'158,'
I AX 61;' 'tar '.tt,'.' 1 A X 1, 1,1 OH;> ?K3tt
1 ,,a •111„11 ,11 1,101 •i 1 Holl .II1,1 I I, t,'1,,I+tlt,
III '►7{ ,41
! ►' 1 ( 9N
Polins'4 made h\ RAN s\ !lv't
t l;iwltiattoll '-"\ sIrn► \:\�I It >
l til)
\11"('1 wcd (ihiih I\tt,) Ihiltl
\ Of I'U\\%-I
I I; 'lll tit BmAcl \
( Wic,
I)t'hIh
Ilot int, 1umliii
1 ), rh ltt,miv Nt mbei
i
lit
Sill 1at C V Ic-"ll ltn)
1},
�urlacr l:ic�atirnt
(halt
_.
i '
. > �. rt �� : D.. i� �
i �' �`+� 21 �: �
I 1 '
�
� .� d /'i �� �f Q N�
; L• 7 /[ I f 1
1
�i4�1A}• �(u/t;
1�%tl%{ 3�7 1
1
! � turf'
7,1 �����
tzutY
3/1
L p� mY sat
16 �r/� `��y
Clay t oo m
: ,
Sung(
1G4/1 Sbf {
t
6
-------------
-----------
x
1,I)d M Mal in" .t1 "I 444.;+--
titantline t;atr! t.11�!;•
Present at lt't I ''I Acp1h
_ how , 'llict h„r ln.c
Not htrunt u, 1 ,ir„ l
t—
(ti
IN
I.tntilitl'. vkal t table
I'tc�a'nt al Iri I ..I tirl,t{, s
! Itrnttti afiE, lxtnnt' _
`:,,! l�li'�rnl to hl,tln,L' I►t,lt•
I -
I
I
o
o
h O
Q
! V
lot
y
4
'D l
y 0
�`u
0
cy u
~c
t
.•, y
Q
P
44
Q
W � �
a
� .g
c
.& .c a
o
O
a •S
o
� c
�
a o
a i
CS .h =
v o y
�
�
y �'
m W
'�"'
u
.'ten .y �. � � �
b i 4 V W O
u
p
Yy
� .. •�
� C v
C y
O��
�
•� i
'. �
a.0 �
� �
y�J
J
aZ
.0 y
a,, l
y
u
Q
'`✓ 'J `,
y �
: a � �
V V
:`, d
a �
V e C
� y
lb
a
�
y
�
oo
Y�
o�
ob
a,
as v
H O,
C
h �I
-it
C 0
r
cck
! .\ !
Q Q
z L
, �kl
1�i
b
N
7
V)
<
Y
XW
r�..
_
��
x
4w) w
I w
N d
Z
Q
cao W
�
o
m
a
n.
tay. L_
a -
V
v7 O V) c \
r � �
J
m m ~ s0
(K �D N ~ W
a LLj L) /> i
W
vy
L
}�
Q /a�o
� 1., o;, to
CO, a
Q � 1
co
J
v
zA
SEPTIC SYSTEM INVENTORY
Site Address: 2125 Carriage La
Owner Name: Kirk & Kim Shibley
Owner Address: 2125 Carriage La Wayzata MN 55391-
PID 10-117-23-24-0037
BuildingTvpe: residence Installer: Hayes & Sons
Date of Permit: 10/26/00
System Tvpe: trenches (SB2) BR's Designed for 5
In Musa?: Yes Shoreiand?:
SEPTIC TANKS:
Material: precast concrete Capacitv: 1300,1300,1300 Tank Filter: yes
DRAINFIELD:
Treatment Area: 1264 Soil Boring: yes DF Ht above Wt: 3
WELL DATA
Setbacks - Well Tanks: Well DF: Report In File: Depth: 181
INSPECTION RECORDS
PUMPOUT RECORDS
Date Notes
Date GallonsOfLiquid
f 8/1/2007 OK
S/17/2017
1500�
6/14/2005 OK
5/14/2013
0
6/30/2003 no surfacing
4/25/2011
1500
6/7/2001 code system, no surfacing
8/6/2009
2500
i 10/27/2000 installation (no well installed yet)
7/1/2006
10/27/2000 installation (no well installed yet)
6/20/2006
2500
6/10/2003
2000
6/10/2003
2000
Z/25 (.;,qye Lnl.
-� I