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Home My WebLink About2000-03-15 MPCA Sewage Treatment Inspectionw i ••k /in m 1 I.i4 L ' ' J Comifliance Inspection Form for Existing Individual Sewage Treatment Systems TTiis form reflects the requirements of the 1996 version of MN Rules Chapter 7080 Mhmctota Polintioa Control Agency Note: Local inspection standards may be more or less restrictive than the state requirements. These dilTcrences must be made available by the Local Unit of Government Dnte of Inspection: -zoc c> Property Owner(s) /)) > /x/Wd L Person requesting inspection (if different than owner) Reason for inspection: a Telephone ( )_ Telephone ( )_ Site Address City Zip Code j Fire No._________ Unit of Government Regnlating thb property _ Parcel No._______________ Township Name __ Raate______________________ Seettoa_________ j/\ f Quarter. (Check ^ipropriate sewer system com;*onent and indicate location on site sketch). Tank fa): ^Septktank __Aerobic Uuik Pump tank __Holding tank Other______ X. Rock trench Other fbrielly describe): _ Alternative system_______ Flow Meter __Gravelless pipe trench __Experimental system. _ Chamber trench _Seepagebed _Mound _At'grade _Warrantied system. Exp. Dale:_____ Other _________ Yes ' Ifves. System Built Prior to April 1,1996 and not Located in Shoreland or Wellhead Protection Area or Serving a Food, Beverage or Lodging Establishment Any System located in Shoreland or Wellhead Protection Area or Serving a Food, Beverage or Lodging Establishment, plus all systems Built after April 1,1996 tri 1. Discharge of sewage to the ground surface? 2. Disdiarge of sewage to draintile or surftce waters? 3. Sewage backup into dwelling? 4. Situation with the potential to immediately and adversely impoct or threaten public health or safety? YES pim?I? Upgrade 10 mo YES YES; 10 mo 10 mo YES ’^O)10 mo S. Less than TWO feet of vertical separation between system bottom and saturated soil or bedrock? YESj^Q LGU** 6. A seepage pit, cesspool, diywell. or leaching pit? Y1 LGU** latheavatam aalPHT?Upgrade YES NO 10 mo YES NO 10 mo YES NO 10 mo 1. Discharge of sewage to the ground surface? 2. Discharge of sewage to draintile or surface waters? 3. Sewage backup into dwelling? 4. Situation with the potential immediately and adversely impact or threaten public health or safety? Is the system failing? 5. Less than THREE feet of vertical separation between system bottom and saturated soil or b^rock? YES NO LGU** YES NO 10 mo 6. A seepage pit, cesspool, drywell. or leaching pit? YES NO LGU** •• LGU - Local Unit of Government ordinance must specify the time period within which the system must be upgraded. STATUS OF THE SYSTEM Based on the compttaacc criteria above the system status is (check one) H in compliance (functioning) □ failing □ an imminent threat thcrofbro, this document is a (check one)yE9 Certificate of Compliance □ Notice of Noncompliance. Page 1 of2 t %metfiods were used to make the determinations for the compliance inspection?. 1) Site Suggested items for drawing include: Well, well setback to system, dwelling or other establishment, tank(s), soil treatment system, reserved soil treatment area, curtain drain, property lines, waterways, and buried lines (those NOT installed by the utility). Include sizes and length and approxbnale distances from fixed reference points such as streets and buildings. 2) Soil boring logs, showing each horizon. Indicate the texture, structure, color, depth of each different soil type, evidence of mottling, bedrock and standing water and whether the material is fill. Locate each boring on attached site sketch. 3) A list of any and all requirements of the local ordinance that are different than the sate requirements referred to on this form. rgOTiOTTATinw A. 1 hereby certify that all the information I have provided regarding the individual sewage treatment system is true, accurate, and complete. Property Owner_________________________________________________________Date B. 1 hereby certify as a state of Minnesota licensed Inspector and/or Designer I or Qualified Employee Inspector and/or (Mlified Employee Designer I that I an investigation in accordance with applicable requirements that accurately determined the compliance status of this system «id that my observ^ons recorded are accurate as of this date. No determination of future hydraulic performance has been nor can be made due to unknown conditions during system construction, abuse of the system, inadequate maintenance, or future water usage. Inspector’s name rnrinh ITTTT _______________ Phone License and/or Registration Number 3 _______ Address iaj kFcJ Employed by *CLfloji tXz A c. Address ____________________________ Valid until that time. Signature. ,, unless the ^stem becomes an imminent threat to public health or safety as defined at Minn. R. 7080.0020, subp. 19a, before Date Urs^mdn Crftnria Mlnnttota StatutM § 116.68 riaw**) Upgnidt R^quiramtiits Any atfuatfon with ffw pote.itfa/ to UnmediaMy and i^orthnatan public health orsaMy, must ba upgraded, raptacad, or As use diacontinuad within tan months of receipt of this ^ rdtNn a shortorpertod of time ifmquirad by local onMnanca. If the local unit ofgovammant with jurisdiction over the system has adopted an ordinance containing alternative local standards, the existing system must comply with the ordinance. If the system does not comply with the ordinance, it must be upgraded, replaced, or Us use discontinued according to the ordinance. if a seepage pit, dtywed, cesspool, or leaching pit exists and the local unit of government with jurisdiction over the system has not adopted local standards to the contrary, the system is failing and must be upgraded, replaced, or its use discontinued within the time required by local onUnence. If the system fbils to provide suHkient groufKhvater protection, then the local unit of government or its agent shall order that the system be upgmded. replaced, or its use discontinued within the time required by nde or the local ordinance. If an existing system is not fwUng as defined in law. and has at least (wo feet of design soil separation, then the system need not be upgraded, repaired, replaced, or As use discontinued, notwithstanding any local orttinance that is more strict. This 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. p;\isis\|wog_dev\exinp9.doc - 6/99 Page 2 of 2 ■f I % i I- V LOGS OF SOIL BQRIMQS Location or Preiact /Zo JT" c^/ _____ Borings made by SWEDLUND___________________________ Date -f Classification System: DAASHO EIUSOA-SCS □ Unified □ Other. Auger used (check two): BiHand Dor Power; DHight El or Bucket; □ Other Depth, in feet 0 1 - ■' ' 2 - 3 - 3Z 4 - 5 - 6 - 1 7 - 8 - 9 - 10 - 1^ BoringNumber xi / Surface Elevation. I ^ ct/ / y ' '/A Ci*»'z)'*^ c!^5 End of boring at feet. Standing water table: □ Present at _. feet of depth, hours after boring. □ Not present in boring hole. Mottled Soil: □ Observed at AJ feet of depth. □ Not present in boring hole. it. Depth, in feet 0 Boring Number _ Surface Elevation 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - % i m. . .. ssiSw ' ■ nfM .j >■ ■ . ■ ; End of boring at feet. Standing water table: □ Present at_feet of depth. hours after boring. □ Not present in boring hole. Mottled Soil: □ Obsen/ed at____ □ Not present in boring hole feet of depth. 'I ■ »’ i I i i -.■•r ■ t } 1 ..