HomeMy WebLinkAboutSeptic info 011.;?�@��20�2 �.3:06 7634988290 /)� F2US1 V� PERC TESTING , ; ;;. PAGE t72
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IMinnes�ta PolEu��c�n � �orr��l�ance Ir�����t�or� ���r�
�e! ������ ��8Y9tiro0 �i�tC1C�' �= ,, � � � ��. � ��,� ��;;��!�,
�'a �MLe}M `!
s��I�aye�r��o�d Nar� 6cl�iting �ubs�r'�t�e �ewage '�P��¢��+�Y �y°atot�s (��4��
r ,,
sc.�au�,nnr��s�s�-a�9� Instructions on page�
9�er��i number: 03-11�-2347-�3n10 � For Lara!7racking Purpvses:
Sys�m status_ �� Gompliant L�NoncumplleM
(b�as���i�n sJf complience�quirements)
�?.��y�i+4i��1��OP(i�
�re��a�rty Informa�tion � �
rr�3��rty ovmer nam�(�): Jc���rr GreelY.... ...,..� ..----- �-- --�---
Pr��.��ty add�ess: �„_420 F�r�n Road S�Oron�, MhJ 56391 ,,�,�, ,,,.__._.__ .—...:-�..—
F���perty nv►m�rs address(iF ditf�rent): 14508 M�Ginty Ro�d W,Minn�tonke, MN 55391 __ -
Caunty: Fisnnepfn �'roperty owner pF��one: 952-933-2818 Pennitting euthonty: _ Ci of Orono _, ,___
�>��sysbe��oon�ivcRed: -Z''f 3/97 :._ Ree�on for insp�erion:� Prope�#y Transi�r,' -,�-��„,�.-r--
����r;��n �scription
�prc�ximately 2-1300 gaUon septic tan�cs,9-15t�0 gallon Ifit stetion�nd�lpproxitnately i50�q��i�
�ry. f�4 of mound rodcbed-... �, .. , "�,° : ^, �, `
,� � � .��,
� ;_�
��•ias�yst�m da�scn���i �,,, , , ,
�:; , k i � �.,,1 a f�t,-^.'C`-:.,..: � a; �a ,.. �. �, r ' e� � '
l:.� �I � it r umb r Number vf bedraorttis e� Design fto�rste {83
p � �. r,�y �� - ,
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Y`te'�`C'�9���l��f�Y:�. ::,� r'z,. _.r �. : '�'... �-� i :d;r�., �.�,'� � �I�:,�l6E�,i�'��E��;�iGN�9f �� ;:. . �„ i �a"a � a.�
i►�Shor�l�t�d erg�? _, �Yes ❑No In Wellh�ed F'r�tectlon Aree? i� �rI],Y�S;, �t�� {,. ,x
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;�n U.�u-Ei7dironenentsl Pr��ec.tion Syete�m geniin�a Minnesata Departr��nt
�" I c,y( �V Inj�cfi+�n Well?�Yes � No of Hedth(FJ�flH)lioensed facility�� .--- -C]Y�es-.�i��i ' `i
8ff
E :� v '.�, � . ;.�, �
G��� liar�ce 5�atu�
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s:. _
4 >; , ����on,state requirem�n�s-additio�al I�I�q�irernents msy�1$a�pply.) j
p [� ( , a
��.a��d orti�:i�forrnatlan.ge�red and reported on attach�d formffi,tF��ampli�nce status of ttti6a systern is(cherJc ot�s): �
54j����t�,prtt¢Idnte°(.,�qmplience-valfd until(3 ye�rs h»m det+e of►sp�ort): 1,*20/Z015 ��
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nt .�.,.......__. _ _._.�
�,otirQ af iVqnG�m �ce-�ar Noncomplierrt�ysfi�ms: .�.... . _. _..
"'�`3��i• �.,.
� , , u3nce is: �_ .... �.,, - --
�z.{ , � + i ,. _ .._....
. nancat��
Th�re�son r,t; , .
; ;, � � �r.ara
T'h�e nancomp4larrt�s�rn ia clssst(iad�s(checkone bsloqw): --
,.r�r: ; -[]Ea#itvti�r�gr+t thte�t tr�,;�btic h��lth�sa�fety ❑FailiaYg W protect ground water ❑ Not.i[t_t�mpli�nce w��tl.operSt�n.�p�Io►t�ik.
��r�.��i�����n(Cg� i��a��,�,ust�Bu��tiee ee�,�°o em�r�d ;�:.:. ,,
�►�F�►�b ���s� t�at�� , � . .,., , - ,� >
�' � , avaer�enentwiitnn 15 __ _ , . __
c�l u�rit af
� �].. .
�,,, ,ar,_ ���r � �ac
, '�" f , y � ` .ly � ll the nt�r:�ssery info►mation has Deen g ta c�tem�ine the compliar►cv st�tf.�of this syst�►rr f'Jt� " -
I s���rrnin�?ia�i�al future�syste�n parfo�mance has been�nor can b�rrrede drre tn unMww►�condidons.du�n�system aonst,ru�f+a».-. ..--.
p:.,��lble,�buae of trhe sysi�ni.in�dequate meintenenc�, or future raeter u�g+x.
, � , ,
6p:a, , � -��w� � � , � A�, �
h�9�rr+�: Jc�s�a�h J Oir�on C��`'c�`�c�tlon nuenb�r: 1255
...w ,.._ . — ^ . -�r-a-�t-' --
� � . � : ��,. � . : � � �.�t �---��^� .�.��,�,..:����� �
`����e�qs�x,:��c.�r;�se„nam��nd�u►n��r; . Rusty Olson's soil and�ercut�tion t�sting Lic#810 . �____,. �r.... ..
�rn�r��r�t: C' of Orono , �, ,,,;.._ , ;� � � ;s.�r �r�,�,. .':.;
R(���Q,�,t��,Esn�k, gav ity _._ _.....___.__.._._
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� oate: �rxa��
ya�..��Bur�s: ----�.�..�,.�.. -...,, � �_..�.,
,� ,,;��,
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���.��ir` .�a�t�����ery�w�. _, inspecxor�prrssst.�:�hls Inspa�ctia�„��4�t I��pages bn�. :
�"'sa��:it C6��S��OIaPta;e���sr'ti9��e'�,,t�;heC�: �Hydraulic Perfnrmance �?'�nE�inCaydty �Soll Sbpeir�tlon (]Operi�'tin�'Pem�R FtiRTi�IF
��rpliceble) �System drpwliti(�Vl4s-bulk drawing Q An�sa�aament of+a�iy i�l requlroments thet ar�diffa�nt frarn v�hat is roqulFw�d on this
;,a�:f�ri�jTr�,��Si�il�C}tin0,l�o�s [���rendar�ment form(k ePProDr�be�?`❑�Other ir��srm�timn�(Ilat): i� �i.�.��:� a��;p;!� �r � �
�� pg ,idS F1��131 n ( Phs olrecei r of this nahce or'wrthin e,hnolMi'!r���aet�bl�heeffh and so1 �s"'"4�'�+ Y r <;°
_, ...,....,.,.. � . �
!! � � POm�nffi ur�nved hom Minn. Stat .^_ qu ii�ty(iTPFi5J�usY sre uppleded mp7cccw or
.:�. �Is u�B di6Con..nt�e�W�tJrP ten mc�n pt . . ps isqi D Ioeal a�Ylnence.M tl,e sY�m:s faibnp.to pmMct grewn+ _ _
v�afer,Phe syst�em muat bA upqradvd,ropJa;eO,or fts use Olscc+nfPnuad wMdn Me Nme�e�uired by lacel ordlnance.If an eristlnp system la nofl�INnp cra da�ln,:d in
�i '`P�W.&!'�fP;�83�Bt MlbSt fiW0`PBei o/ff8��(/n eoH sep9►eNon,lhen Nre ayadem need nat Ae upqradad.repsksd,►splace0.Ot lfs us0 dleaunlA�ue,�.nofw�thstendinU wny
� �,x.el adl�anca thst la mae sb'fc�, This provia�on daes not eppJy to sy�ms in stroreland a�sas.YIMIU1eaG f'roQ�ecNon Areas,or Hroaa uaed'm connettran uINI fxrl.
dla�na�►cr,�$,t�^d aodBJnpi�ebNsfi�i�ae der�ured inlew. _ ._ ___.__.... . _.__.,..___.....__.
�y�f � iLC.vi r I,i�.i rd f�� .� � ... ..., � °'�^ , ` .. C�m �
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�<r � �� .<: ,��� . , ' �,;�r., ti;��..r.�p�:�a�in�" lance/n� tir}r�'F`o►'ryi o'r'Exts't��i '�5�'SE
w�evw'rsi�=3y Pr l�'f � �
, � 3:06 7634988290 F�2US'i-Y5 PERC TESTING PAGE ��.
01/2�/2012 1
, .: �- ,. _ __
_. . _ ._ _
Par��1 number. 03�117•23��-t�t110 _�,._ System staAus= �Compif�rrt ❑ Noncomplie�t
o-. .— (aa detemuned by fhis form) , :, , , . ,
� , ,� . . k i�l,;I�C6,,�
��r�auli� �'sr�rrnanc+� �nd Other��npl�ae� �,� ,.:�,
�r�r��lianz� Issu� #9 af�� ' '
C7ut�tr�obs+e�vetfan: 1/20/92 Reeson for obs�rv�tfon: Pro Tr�nsfe� _, _ _.___,.-_
'1`t�l�#'br�n expires upon ne�R inspaction or in three yeers,uvFtichever oCcur�fsrst: 1/2DI2015 �,._., .._.__
�i�:�91ar1r.�c������srJcritsr�' (�equired) ��rifiCiltiOn Method': (O�tional) _
__�Check the app�fe box) � •-- (Check the epProPriatv box)
Ua�s��'�+�systern discharge sm���e to the ❑Yes � Wo � Sea�ched for surtace outi�t
�rou.�cii�urfac�7 .
. ❑ Perfnm►�hydreulic ta�,st
�3�s�{i�sys�sem dfsche�ge st�uvsge to drain ❑lf� � ��
tiil�ra��u�aoe w�ters? r _-w_...__ � Searched for seeping in yard
Ct���e sys9err�ceu�e serwage bacicup ❑j'u.� �P10 I�1 Chedced ior badcup in hame
_,.__
I�n��:w�lling or est9bt6shment? _ ,,�;I=" _ _
_��_� ,_ ❑ �Exoessive pondfng in soii system/D-bo�e's
l7�c r�s��r situafions�xiat th�Y ha�ve the ❑�°�3$ ��n ❑ Homeawner tes�fmony
pu4c�r��4al to immedi�tely�nd adv�rs�ly
I�p�t or threaten ublic health or safety LL,. _ _ .__ ; , � �'�mined for surg�n j :` '
� g in tarz
�n"ye�sp��,�r lrnil��syatom!s an�'r�a»Onern '' � S la em re uire�e�mfl di�pert3�l�`��stehi
�t�. ncal,u s:�fe c.�ver� etc. 7
�D�^�2 a6o pecb!(�he�IPh arrd� ❑ 5/$ Q �t'per�c�'pumping
„r.__.___.�_ M.... ----- .r ❑ Perfvmned dye t��t
D�;��24p�'F�t�{n:RnEe,a:thr�at'tq:�rQ�+►�d ❑Y�P���:�:;P4Q.: �,- �:; [.1 Other.
va'�:�f�r eny wndi��r►s deemerr9 no�- `— -- --
�s�riective,a�::deterrnir�cl_[�Yth��n oi? ..^_ �,....�, _. ..._ _..
,•Y�.�.,'��ad�r.at�:t�s�t tlrs,�ysrarr►Is fslNn�tv prot�ct > Y ; °.°,� . �_....m._..._.-----
g � ter fl� �•,,descrd�the conditian a�tod: . . .
f�e�.a�a9� " ; y :, . , � .,a:: � . ; �Ado starrdeid prutocd ezists. 7'his.list/s rrot exh�ia:�li�a,. ..
�
�� ; . :
—__ i�r srtquar�Bel ader, nor c�oes iP indicate which
;��,qr#�����M�� rg:��d.,.r��r,�r i;, b�u �� i-::: , .�_�_� �`��rrbfnaefons are n�c�s�ty,#u make this deterrr�;nati��i.
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�����f�C���ea�
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�u�ryt&S'ESi'YYt i�tU l�i�Afl1���Ad:'e�ttt��attached to the Saamm�ry 1=orm of the�t4innesot�Pollution Control A�ency's(NIPCA)Corro;�3u:���
1���'6071�eTn+l�+flf EXI��iPI��UI38UI�ace 3ewa�e Tt�s�finent Sys�rns.dbservations, interpie�tations;'arid cflnclusions rr�uur h�
car�;�i�ted by�n inspector. Completeci form must be subrnitted to the local unit of government,w�tp�(�n;�;�;�y�.
Pra�;�r�y-o`wrrtiar��arr+�(s):. � ��J�si�n��ree� '� � �,������41r�� �c�ie ��i��:���� � ����,�,;�-:;
. -........ _
���?;,��a��gas' �2�B[+owri�Rt�d 5,Orono,MN+553���1�.� '., ,.,�§I�s:.>r�s.r _,— _� .
� ,s� � a�t;�.r.__. _ � --
3��Y�,^��.�rty a��r��d��t�'�E�eier�): ' 14508 MC Girrty i�oad W.Minnetonke,MN 55391 °' �ro1 �tt., ;*`:t:��,i�
; . ,,, , � Ph �� -;�� Y �
�7Ci , _ t�� � c�!:;.i .
C.�lllitiy: �44Rf18�ifY . g�'�
G.�j;r� -Tr-*,tr4F— :...� '`"k�—'i',.+,�,r: . u.�..._. ., . -. : . , . .
csr��_ 852-932�2
�b�'•v7dn� .,:,t: i: l�:,rAi, ,.�.` , i.;, � � 9 7:)t{'�Pr,.}� �Y,l�r, �'"
�re�eby certlfy ttret 1�ersonelly made�the observations,tnt�ipreta�ions,and concfusions report�d�n this fomr and that they e�
__ _._ _. .__ _
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`C7J79'r3t1F. _. _
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��::�,;,;�: �����t�J:��sa�ti '` _._. _ �, CsrtiAcatbnnumbeP: 5256
� : �--�.---
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. ....._.. . .
" $�►��me�nd numb�r: Rusty Olson s�ii en�rca�letion testing Lic#810 __ __�,„� _ �r
. .
u�ir�sass �c�n
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� .,' . � � . � .4 .i ;:i.ii��a �, .. -.
f�'t'�Jfilk:��2�Pr81�llfitQ �",Q�YTSfi��'3i�� .;'; :C.�IOf�fOT}O" � . . _... . ..
.� � � . , ,y.i., � , ��' �..; `i . ,. .. . �. ' .`NIlth�e�.�iti?F—
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'!'".,_.7 .. � � �. . . .'��Ik�.�1ii:���S:r I.Y ,.. .,va.��I��friWY%"�.
',i,�,�� . .�, A�A.,y�,r� .
wQ-�+ro+is�s�-�9 ComD�fance I►r�peciion Fc�rm for Exisgi�r� �5;�'S
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r�,.�.,.,rr. � 1.• ,qr,t �,� 1 r, ..... . �,. ;.0.''�-' ,— — . , � u � --��-. ..y;._i . iWr; . ,..",�r1� i�7i��N�+r,l 1�.'.F���r',�� I'.� i ll i.�i�{;�`fl�:'��:
01/20/2012 13:06 7634988290 RUSTYS PERC TES`�ING PAGL 04
Pot+c��l nLr�b+eP�; 03-117-�3-�2-t�010 System st�tus: �Compliertt ❑ Noncompliant
. -"" (as del�ertnirted by this�onn) " �!��:�°
� ;.�:
T��k 9ntegrlt�/ snd Safi�t�l Canpllar�o
;;.
�o�����nee Issue #2 of �
De4a af observatlon: 1/20l1'1 „ R��son for observetion: Property--Trensfer _� _ �._
Thls Yorrn expires on (three yearsj: 1/20/2015 _. . „ -- - ---�
�r���ll�nce ques46onslc�tl�: (Requlred) Veriikatlon Method°": (Opuon�q
�heck the a ro riahe box (Check the app�priate box)
D�a���he systom Consist of a se�sp�ge plt`, ❑Ye: � No ❑ probed tank bottom ,
cc:��ool d II,or leachin It7 , ._._
— " ❑ Observed low liqufd level
t�o�r►y sewege tank(S)leak below their ❑Ye� �No
dssi�Jned operating.depth? _ � Exemined oonstruction records
`F ❑ Examined empty(pumped)tenk
yc��,uierrtify which se�wage .
tar�tc��8k.s. „ ;"
_ ❑ Probed outsfde t��k ft►r"black soil" ' "' !
�17�i'`�i"IM3tHR/h�CBf��i?th@ BySbsln�9'tYI�Y'i�b6 pl�Ct
�r��wstter ❑ Pressure/vecuum c9se�ck
� Other: Wete�level correct _
u �r;;���g�pi�g me�ting 7�0.�5t;U may be compliant if�Iloaved �r , .,�� ' :
irr�r�in�Vice by local p�rmittang authority.
>""�r;
_ __-,_ --
''"No sfendard protocol exists. This list is not ezhaustivrr,ln
sequentlel Qr�er, nor does it indicete wh�h com6inations
ar�a necessary to make thls determinetion.
� � _ ,, e�sw�::
�&'����/ �hE.'C�(
1 ' �,re�ai�y malMenanoe�hole cx�mer�damaged,crac�:�d,or e�eared to ba�ttruucturally unsound� ❑Yes' � �lo
� , , ; �
�`:� q�ler'�"�II m�irrten�nce hole a�vers replaced in a s8c:ured m�rrner(e•9-,�II sc,�+ews replaoed)? _ �Yes---.��.f�Jo«__.
�, '' '�r'��x , ,
, , .
seoondary access re�kraiM P�M(��Y P�n,seco�d caver.or saFePly netting)-hlghly r�c�rnmend�d. Yes ___. �.._
�;;srr;�lt,s�any o�Me�r.�f�oty/ha�l�;is�ue preeent7 • G . ; , :; '' :�-- _,.��;; ❑Yes' �PJo
__...r :_..� .. • , . .
��9(j1�L'!�!: : . .,w ..,.,,_ ... . � ;� ,--_ ---
wG�Y; :.' - � ..,.
ys DrnmJnent 2ir�t to publlc h�lt��rrr1 rsafetr. ' '. '
� �em ia ar�
...
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_ -. _ __ �l +,:�', ., ��� ir.�rn�;�s;�iui,.'�ifis�V�2�
�;���;`�'�iC��94rt , ,� . _ � � � ,,,: � .:.c.�, f�� ,,.
_ ,
TI�?:���,�-m"ss to;�completed�r►d attached to the Summ�ry Fortn of the Minn�sota Pollution Con4roi�lgi�ncj►'�(lVIPCA)Com�ll��nc�
l�•ta;���on Fortn fo�EYistlng Subaurtace 3ewage TreetmeM Sys�em�.Observatbns,irrterpr�i�t�ans,and,corldusions must b�
c�r���1�ed b��.r�lr�s�tp[�ma��+tainer,or ssrvioe p�ovider.Comphted iomn must be submitted to th�ioc�l unit of gov�nmen4 witt►in
�v�4��1;��. � � . .,..
�ro�rt�e own�r.�ame(8�;�n�Jo6�r��i3re,�lY �,;m ' "'�s � ,' ' ` _.__ _. __..--.---._-
Pra�i��ddress: �°420 Bror�rri Ftoad 5, Orono, MN 55391 M_� -_ - .__�` `.
., • ,,,� ��,�c ;j sP i+�, +11
P�roperty oamer's address(ff dltt�r�nt): 14508 MC Gin Ftoad W. Mlnnetonka MN 55391 ,�,,,�,;,1G_
Cn�r�4�r� Hennepin w,. _._ Phone: 952-933-281�t �F�';`,e`','�,�"w',:�,,,.
I�, +'; I i
ie��by cer�ll'y t�iet I pe�sonelly made the obseroations, int�►p�etaliens, �nd aoncJus�ons ieported on t�iis fam ond tha!they b�
Gorr�cCf. . , � ,. , , . , . ,,. , ,, ^ � . ,. �'�,
,. .__�_ ._ ...�w.: ,x.. .. �. f� �:
,, , + � ; �C�
. , � , . � i
Ide7rslc: Jsse J.Ols�ori `. . K _ ._�� Certlflcatbn numbe�: 1255 ,_„_,,, _ .
. ,.�; ,. �;�:,�::.:, �� : ,�
�u�isresa`ticen�e►iarrie'arid riumioeF: Ru Olson's soil end per+a�latlon�esting Lic#810 , .__ ��r
�--.._...,.._.. —,�-�
,F; 'u�,;;
P��rr,L of Irtcal uni gove�nment:`' City of Orono �, _ _ � ,��
,.
Si�it��u�' _ _ _ .._ _ ..... _. Dete_ _9120/12 --__.____ _ ._._.._. .._ .
.t;.:.. ,. �� . �:�-. �r,:-s ., .�;;�� , ,f,- .�� ..
�,rr-���,:�crc�-.�f Comnllance Insoection►�orm for Exrstina 55�'S
01/1012e�i2 13:06 7634988290 RUS-I-YS PERC TESTING PAGE �5
�arcet�zumber: 0�117-�342-0010 _ System status: �Compllant ❑No�c�ompliant
_._ (aa dete►mined by nhis iorml
Sotl �►paratlon Corrrpllaneo s�d O�her Con�pllance
�orr�pf�ante Issue #3 0� �4
i�ete df ob�erveUon: 1/20/9� � Re��on for obeervation: Pro�er�Trensfer , �, �.
7'P�is tnlbrmeflon on this fiomr does not e3rpi�e.
Ce�i��i��noe qua�tlonslc�fteria:(Requ�ree) Verlflcation MelhodR°: (OptionelJ
(Ch�►ck the ep,�ropri�te box) _ _, (Check the appropriete box)
F�r�ys�ms built prior ta April 1, �i 996,and not � Conduded soil obs�rvation(s) (attach boring lop�;)
Ic�cs��d ir�Shoreland or Wellhead Proteetion
Are8 ur�iot eerving a fiood,bev�r�ge or ❑ Tv�ro previous verificatlons(ettech bvring logs)
iadQing astablishment: ❑ pther: ,_ ._.�
Do����s��ystem have at I�est a Mro-fi�ot
v�riicad�eparation distance fi'om perlodicelly �",-.--... -'""'---
.. ,_.
s�lurat�l soil orbedrock?. []Yes No '
Far rs�rcr-�rformance systems built April 1, ,�„..� -- �--
19�,cr l�ter or for non�perfom�ance syaiems
1�:".;�In Shoretand or Wellhead P►vtection ����akian does not exQir�e,Previous ob�ervetiots$
�r����s c�r senring a food,beverage or lodging b�r two independertit pa�es are suAident,unless site
�st�biishmen�: wnditions have been eltered.
I�a:3a t��systsm h�ve a thre�foot vertical
s�p�zrr�ttipn dist,anoe from periodic�lly satureted
s��l:�r-tsedcvck7• _ .___W�„- _ Yes No _
Frsryreduc�d separatio�distanc�systems(i.e.,
"p�rfibe�i�n�"�systems undar old 7080.0179 or ' May be reduced by up to 15 pencenf if ellowed in lacal
ryl�IV or V..s�rsiem under ne�.v 7080.2350 or o�rNneaoe.
,,: ___ _- ._._
'�J�): ••�vo stenderd pioro�ca exisrs. Tnis Jfsr rs nor exnausbve,
[�=a,'�«'�ystem meet the desigr��d vertical in aequentfal ader,nor does it indic�te which
,• canbinatians en�neces�sery,.i�make this
sa�s�z��rdn distance f�nm periodicaally saturated .,..,
soiE sir h�drock?' ❑Yes No delem►lnetion.
...- .c ��;,-:.
�r�%.�.��rt�r�r hrdKa¢�ae th�Y�syst�am la lS�NIn�b�piotect
Y�' "
� ; . . ��;i;r.sr�r���ua�tie ,�,s ;;�'«w�1�..;, :����iriti�Rr���,�1
„
.i,.:.� _ �' t� W
... � �4'.;' � .. .. . ,� . . . . . . l..': ...�'i1�l�irA1����t6�C l•:d�;1Y�'t��E wi�..l . .�:���' .
��'����ation
�_,�:� � T4: ,..�. ..
T�is fprm,is to,be completed and attached to the Summ�ry Form of the Minnesata Pallution Control Agency'�(MPCA)Compllan�e -
In�par�tic� Form for Exlsting Subsurface Sewa�e Treatrnent Systems.Observations,interpretations,end conclusions muat be
_._._.__., . ._
�ni�Eet�d by en inspedor or deaigner.Completed torm must bs submltted to the local unit of govemrnerit wlthin t 5 deys
;, ; , �. .,, _
, ,.
Fru�,�r���ty awner name(s): J�M�Greely ._— r M r�
�,.z •,
,� . . , „��..--
A��,�
�'�;s�►ty adcin�s: 420 Brovun Road S Orono,MN 55391 ` ''�� �;;, .� ;��
.. ___ ��;
�ra�o�y ovsmers address(tf ailrerern): 14506 M�Gint�Read W_Minnetonka, MN 55391 , .
ui.,: .
�q�. y r ' ',H�nnepin, ,. Phone: 952-933-2818
�,, �. �.,.....�._— . -- •
r�iQr��y�cam ,,
'�yy that 1 porsonslly made fhe obse�vatlans, interprefations, and cvnclusiQns nepoited on this form and that they a�
� �. ,�.
. ,
car��ct
. � . .r�...:�; _ � , ..,.�.����:
;,., �, ,, . .
�i�j�j�� �Jo�ph J.Olson "'' Certificetion number: 1255
,x. . _ .,'t' � , .„ , e � � ,rlX.�lD i�9,
Buair�ess Ilcense neme end number: Rusty Olson'a soil and perculation testln�Llc#810 . _ or
.,.)4P; .�G� s�l�, .,�� , , .. .. 4(,� . .
IV��a�ofiocat'u�it emmerr�:J Ci ofOrono _a. � ,: s:.;. :;;.. .----.–
. : ��, � -,
���� :
Sigr��,�re: Date� 1/20/12
. ,3r r� ,tia' . ,n�r;, . 9�r r . . - ....
.��:d.''J��r i.,.... .
�,;.wnu,tcrca.�� [omnllance lnsnection Form for Ex�stina SS I S
61/20/2612 13:06 763498829e RUSTVS PERC TESTING PAGE 8G
Loas of Sofl �orinas
L�cense�810
Loc.�tion or Project; 42D Brown Road S
B�rings made by: Rus�l Olson's Soil and Perc testing 1/�0/2012
Classi�catlon System: AASHO ; USDS�USDS-3C8 X ; Unified ; Othe�
�a���r used (check two): Hand_X_. or Power , Flight, Bucket or Probe,X_
�nch mark is top of basement concrete slab. Elv.-100.00 Assumed
Boring Number_1_SurFace elevation_98,7_ Mottled Soil at�2.0,feet
0"-16" Fill H20 p�esent at_X
16"-2�"Dark brown loam 2.5y3/1 _ ,_
�oring Number_2,Surface elevation_97.7_ Mottled Soil at 2_0_feet
C�"-24"Dark brown laam 2.Sy3/1 H20 present at_X_
T�3M: Top of lifl station manhole oover Elv.-100.00 assumed
uriginal grade under ihe rockbed Elv.-98.9
Ba�#vm of rock bed Elv.-100.2
There is 1.3 feet of sand under the rockbed
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61/20/2012 13:06 7634988290 RUSTVS PERC TESTING PAGE 0?
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; � il' � ,i I`- � // Municipal Offices
��.'� ' �' ` �' r <'� `� G�' Street Address: Mailing Address:
\. � i��, , � ,, �.�i ,/ P.O. Box 66
��9� p� 2750 Kelley Parkway
��/ Orono, MN 55356 Crystal Bay, MN 55323-0066
To: The Current Owner of Address �'� �C� ���� � S
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 receipt of this notice. The septic system must be brou�ht into compliance
within 90 days. Failure to do so will result in referral to the City Attorney for
legal action.
System Identified as Non-Compliant
Yes �r,T�
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 recommends the septic tank(s) and/or lift tank be serviced and pumped
out every three years. City records indicate the tank(s) were last pumped out on
`3.- I �'C�(n . The tank(s) should be cleaned thxough the manhole and
not throu�h the inspection pipes, tlus allows for proper cleaning.
Comments:
�,��^ ���_�, ����
Insp
ect�o�`:— ��"�—— Date of Inspection �= � �
Telephone(9�2)249-4600 • Fax(952)249-4616
www.ci.orono.mn.us
= o�
�. �
- o �
���- o\,,,
� y� C I�Y of ORO�TO
. . �
,., �:a r,�. �
� '�i' ��„ <,;t,;'� , �, Municipal Offices
i:,�:i�,l.'.., i f.:'y.. 'iA� �� �.
`'�,t � .�<. i;;°�,�,�;, ,� Street Address: q5a-a4q-y6o 0 Mailing Address:
'����p� 2750 Kelley Parkway P.O. Box 66
- Orono, MN 55356 Crystal Bay, MN 55323-0066
To Current Owner: Address: �a`� �J���'"^ Rd� s �
City Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every two years.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the categories checked below.
S STEM CONFORMITY 1-3 : �
1 "CODE SYSTEM" An LSTS which meets all the location,design and construction standards of the current Orono Municipal Code.
2 "COMPLIANT SYSTEM" An ISTS which does not meet all the location,cksign and construction standards of the current Orono
Municipal Code but does meet the three foot separation requ'vement or two foot requirement for systems installed 1996 or earlier,and
which is not failing or an imminent threat to public health or safety.
3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-yeaz flood plain,any IS1'S which may r
or may not meet all the location,design,or coasiruction stan�ards of the cuaent Orono Municipal Code and which is failing for any `
reason;and any ISTS with less than three feet of unsaturated soil or sand between the distribution device and the limiting soil characteristics.
TANK CONDITION(5-7): �
Tank inspection indicates:
�Pumpout not needed at this time.
6 Septic tanks must be pumP�ed out this year (city code recommends tanks to be pumped out once every 3 years.
Tank was last pumped /31-0� ),
Make sure septic tanks are pumaed throu�h manhole and not throu=h white inspection pipes. This allows for the proper
cleaning Keep water softner and iron filter discharEe out of septic svstem to prolon�life of drainfield. Ask pumper to test
alarm float to verifv alarm is still workins in vour house The atarm warns owner that septaEe is about to backup into bas_ement.
7 Inspection riser.s missing-tanks could not be inspected. Inspection risers(4"dia.pipe}must be mstalled m each tank. If
tanks have not been pumped out within the last three years,they should be pumped out now.
DRAINFIELD CONDITION(8-10): �
� Drainfield is dry,no surfacing evident.
Some evidence of surfacing,not critical yet.
10 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately.Repairs must be completed within 90 days.
COMMENTS: �o v'�v d' _ _ Se �-,�- �°`�kS I bD�C � .
�_Z-�- a� ��'``�C
Date of Inspection Matt Bolterman - Septic System Inspector
Note: In the event diat 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 properl}. but is mercly an opinion of the adequacy of the system under current
conditions based on the available inlorn�ation.
�
o�
o ::,_ o
=1�-:_ �=�-� C ITY of ORONO
� ,�.��r�:� ?►
.
� ;� ,�;`�'�r�}�;;T� �F�r Municipal Offices
"�''��`�.'�,,��'i:� n, G
�`�,-�'s ;v,���.� Street Address: Mailing Address:
'� ��°r,ii �,
k�gg0 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
95d-�49-4600
To Current Owner: Address:
��� ��c�w� I`� S_
City Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every rivo years.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the categories checked below.
SYSTEM CONFORMITY (1-31: �
� "CODE SYSTEM�� An ISTS which meets all the location,design and construction standards of the current Orono Municipal Code.
2 "C O M P L I ANT SYSTEM" An ISTS which does not meet all the location,design and conswction standards of the current Orono Municipal
Code but does meet the three foot separation requirement or two foot requirement for systems installed 1996 or earlier,and which is not failing or
an imminent threat to public health or safery.
3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-year flood plain,any ISTS which may
or may not meet all the location,design,or construction standazds of the current Orono Municipal Code and which is failing for any reason;and
any ISTS with less than three feet of unsaturated soil or sand between the disvibution device and the limiting soil chazacteristics.
TANK CONDITION(5-10): b
Tank inspection indicates:
5 Pumpout not needed at this time.
� Septic tanks must be pumped out this year (city code requires tanks to be pumped out once every 3 years.
Tank was last pumped )•
Make sure septic tanks are pumped throu2h manhole and not through white inspection pipes•
This allows for the proper cleanin�.
7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank.
DRAINFIELD CONDITION 11-14 : �
8 Drainfield is dry,no surfacing evident.
9 Some evidence of surfacing,not critical yet.
10 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately.Repairs must be completed within 90 days.
COMMENTS: 5 y s'�`c^� 1 o L��,S ��_ {�� MA �^ICS ��,S �I1 - ^^5k�
�� � L � ��w- ��. Sc���� },�...� �ErS Lle.,.��. _
_z� -oa. �� ��-�-�.._
Date of Inspection Matt Bolterman - Septic System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortga�e or other transfer of property,be advised that this report does not guarantee
or ceRify tha[an eristing system will continue to function properly,but is merely an opinion of the adequacy of the system under curtent conditions based on the available
infortnation.
o ���
�� � � \
�
0 0 �,
- CITY of ORONU
r� j ��j�.. . �'► �
a�,, ':y . �r;',' Municipal Offices
� ,
� � -� � '�� Street Address: Mailing Address:
.� " %r
��`��$'EggO�'�� 2150 Keiley Parkway P.O. Box 66
` Orono, MN 55356 Crystal Bay, MN 55323-0066
September 25, 2000
Karl & Kacey Rasmussen
420 Brown Road South
Long Lake, Mn 55356
Dear Mr. & Mrs. Rasmussen:
An inspection of your septic system was conducted on September 21, 2000. A summary of the
inspection is below.
Septic Tank Condition
1. Pumpout not needed at this time.
The septic system is a compliant system, meaning it meets all or most current City and State
Standards. Enclosed is a list of licensed contractors who work in Orono on a regular basis. This
list is enclosed simply for your reference in case your septic system needs maintenance in the future.
Also enclosed is a fact sheet explaining your septic system and how it functions. Finally, an as-built
drawing is enclosed showing the approximate location of the septic system.
If you have any questions regarding this report, please contact me at the City Offices at 249-4600.
Respectfu ,
1
� �
1� �/� V •
Chris Pence
On-Site Systems Manager
Enclosures
In the e�•ent this inspection report is used to satisf�the requirements for a mortgage or other transfer of property,
be advised that this report does no guarantee or certif}�the eiisting sy stem�vill continue to function properly,but
is merel� an opinion of the adequacy of the s}stem under current conditions based on the a��ailable information.
This report must be kept on the premises with the system location and pumping records.
Telephone(952)249-4600 • Faa�c(952)249-4616
www.ci.omno.mn.us
/ O`\\
7 � �V�
O O
� � CITY of ORUNO
� '1�., �,,,
.�,, :�. trr,'j Municipal Offices
� .-- 'ti/;
� � ���� � �`�`� � �� Street Address: Mailing Address:
� ���� �i ��
� `��,`9�fEggOg%� 2750 Kelley Parkway P.O. Box 66
�=----�% Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: � �( ? (/ ' ��� �`j �'}�) U jS-�./'� Address: 420 Brown Rd. S.
Permit #'s: none Dates: Contractors: unknown
(This is [,� an existing system [ ] new construction) .
/ '
SYSTEM COMPLIANCE (1-3) : 3
1 Code System: Meets or exceeds current City standards in all respects relating to design,
cor.struction, and location. Appears to be operating properly.
2 Compliart System: 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 a.^.d is functioning properly.
� Non-Comoliant System: 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 dra�nfield and the saturated soil level.
(The saturated soil level is [� ] or is not [ ] identified under this septic system. If the
saturated soil level is not iden�ified, this classification is subject to revision.)
TANK CONDITION (5-9) : 9
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year.
7 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.
�� Inspection pipe is located over tank baffle-can not measure solids accumulation. If tanks
have no� been pumped out within three years, they should be pumped out now.
10 One or more tanks are cesspools, which means the septic system is non-compliant.
(The tanks are [ ] or are not [ ] water tight or the condition is [x] unknown. If the tanks
are not confirmed to be watertight, this classification is subject to revision.)
�AINFIELD CONDITION (11-14) : 11
rl� Drainfield is dry, no surfacing evident.
�12 Some evidence of 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: (system age and condition, soils, etc. ) : medium
COMMENTS: In order to confirm that your septic system meets Minnesota standards, soil borings
were performed to verify a 3 foot separation between the drainfield and the seasonal water table.
The separaticn is 0 feet and the system is non-compliant. Repair or replacement of the septic
system is required by 12/31/2008.
'L� ���� - J� .� , - �,�' �----
Date of Inspection S ic 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 a � ON–SITE SEWAGE TREATMENT
„� � INSPECTION REPORT
ti
��9kESH�4'�G
Owner: �l�! I�_�1 r.��1��2� Address: ��� (�Y�1.�Y�� t`C�l� �.
Permit #'s: /1.°')►'`'� Dates: "–"- Contractors: /J���it�)i�11^,
City ordinance number 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 ,yV an existing system [ 7 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 uhich 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 ,J�has not been identified at this time. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONOITION (5-10):
Tank inspection indicates:
5 Purtipout 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. 7anks should be pumped out as soon as possible.
�r �System is discharging to the surface. Tanks must be p�xnped out uithin 48 hours to eliminate surface discharge.
Inspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
/,f3� tank at next pumpout. If tanks have not been pumped out within the last three years, they should be pumped
J' � out now.
j4 10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
r If tanks have not been pumped out within the last three yearsl they hould be p'mped out nou
�
� �
DRAINFIELD CONDITION (11-14):
q4'e�field inspection indicates:
lll'� Drainfie[d is dry, no surfacing evident.
"°t2' Sane evidence of surfacing, not critical yet.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately. Repairs must be completed within 90 days.
14 Drainfield extent and condition unknown.
LIMITING SITE FACTORS (slope,setbacks,etc.):
POTENTIAL FOR SYSTEM FAILURE (depends on soils,water table,etc.): �
COMMENTS:
�
�— ' �.
D te of Inspection Se i System 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 opinion of the adequacy of the system under current conditions based on the available
tnformation.
This report must be kept on the prEmises with the system loc�tion and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
CITY OF ORONO � O�
Municipal Offices O � O
Post Office Box 66
Crystal Bay, MN 55323-0066 � � ON—SITE SEWAGE TREATI�NT
r�, � INSPECTION REPORT
�' G~
��kESH�4'�
Owner: `✓�Y��I�i�1i^1� �IJ�/1,P.� Address: �� p�t�l+/J''� l�ldi �.
Permit #'s: �G3�Q Dates: Contractors: �
City ordinance number 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 uaters.
"CONFORMING SYSTEM"-A system uhich 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-CONFORM�NG 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. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDIT[ON (5-10): �
T�n1c inspection indicates:
C.S� 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.
8 System is discharging to the surface. Tanks must be pumped out uithin 48 hours to eliminate surface discharge.
9 Inspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
tank at next purtipout. If tanks have not been pumped out within the last three years, they should be pumped
out nou.
10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
If tanks have not been pumped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION C11-14):
D,rp�yn field inspection indicates:
�N Drainfield is dry, no surfacing evident.
12 Some evidence of surfacing, not critical yet.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
imnediately. Repairs must be completed uithin 90 days.
14 Drainfield extent and condition unknown.
LIMITING SITE FACTORS (slope,setbacks,etc.):
POTENTIAL FOR SYSTEM FAILURE (depends on soils,water table,etc.): /JJ��`
/,F�
COMMENTS:
'foZ/— oZ
Date of Inspection ptic System Inspector
Note: !n 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
properlyi but is merely an opinion 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 toc�tion and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
On the North Shore of
Lake Mi�anetonka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
1335 S. Brown Rd.
� � � Crystal Bay, MN 55323
473-7357
OWNER ��Y�S ��r�hC� ADDRESS `1�C� /J►��l.�� fK[�� SP�
PERMIT NO.'S. _ 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 address 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 respects relating to design,construction,and locatio�.Appears to be operating
properly.
� 2 Does not meet all current City standards for new construction (1978 Code) but in most respects appears to be designed,
located, and constructed generally in accordance with previous codes.System appears to be functioning properly; no major
upgrading of the system is required at this time.
� 3 Does not meet current City standards in many respects relating to design,constructio�, 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.
� 4 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 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 witl usually 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 accumulation 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�ow.
❑ Solids accumulation in tanks is at a critical level. Tanks Drainfield inspection indicates:
should be pumped out as soon as possible. �Drainfield 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 risers missing—tanks could not be inspected, effluent to the surface. This condition may require replace-
Inspection risers (4" dia. pipe)must be installed in each tank ment or additions to drainfield. Contact the City Inspector
at next pumpout. If tanks have not been pumped out within immediately.Repairs must be completed within 90 days.
the last three years,they should be pumped out now. ❑ Drainfield extent and condition unknown.
SITE CHARACTERISTICS:
Limiting Site Factors Potential for System Failure Site Capabilities tor
❑ Slope (depends on soil types,water Future Expansion
❑ Soil table and system condition) �Adequate
❑ High water table � Low ❑ Fair
❑ Lot size O Medium ❑ Poor
❑ Lake,wetland,or stream ❑ High 0 Inadequate
❑ Drainage ❑ System is causing visible
surface discharge.
COMMENTS: � ,�i?�DP(� /�9^� Y'S=P� �7r/' �"C_ ]{1��v►lI� IY� ��✓�t ���- �i�Tlj)i. �'��
1i�4/�
�
/�-�n-�'c� -
Date of Inspection eptic System 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 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