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� � Minnesota Pol{ution Cor�pliance lnspection Form
� � Controt Agency - ��=�1�
520 WfdyetteRoad Nath Exlsting Subsu*fsce Sswi+ge T�estment Systenes (iSTS)
sc.Pau�,MlV 5515�4194 Instructions on page J
ParCel nurnber: FOr LocalTracldng Pu�poses:
System status: �Compiiant ❑Nonoompliant
(besed on all c:or►►pi/enCe leqvirer►tenls)
Sum�nary�onn
Property Informatiort
Property ovmer name{s): Ke�th Fritze
Proper{y address: 25a5 Coun ei�fe Orive,arorso MN 553b6
Ptoperty ow�net's addcess(Nc1MAeronq:
County: Hennepin , Property owner phar►8: 952�7�9703 Permitt+�g authority: City of Orono
Dste-system�o�s#�: f4/4'N88 Ressor+�oc� R�r Tcac�ter
System Des�ription
A,p�ly 2-tODD galton se�ic lanka,1-1000 Aalla'�IiR stetion snd Approximately BSO squere
8rief syatem desrxipEivn: feef of maund rodc6ed.
Locel permit numbet: Number of bedrooms: 5 Design flow rate: -83
b the aysEem:
tn Shoreland area? [1 Yes �No In WeAhead ProtecUon Rrea'i Q Yes (�Fio
M U.S.E�vironmental ProteCtloa 5ystem serving e MinnBsota Department
flgenc�+t�flR3 c�asa v lnjecr;ort vve�F�B Yes �t+lo �c Neat#(AAt1h)aic�nsed tacUtt� �7 Yes �N�
CompHance Status�a05ea o�state requ�re�nenta-addic�o►,aI 1oca1 req�remerns may a�so epply.)
Based o�the informaGon gatt�red and reported on att8ched iortna,the oompli�oe staEas of tlris a�stem is(chedc one).
�GeRtticate of Gomplience—vaiid unhT(3 ree�s Nnnr defe of�epo�tJ: 5/Z111(Tt� --
❑Alotice of NonCc+mp6ar�oe-�ar Noncompliartt sy8tems:
The teasvn 4or noncd'r�ptience is:
Th!s noncompliant syseem ia classlfled os�check ons bslow):
❑Imminent threat to pubiic health 8 sefet� ❑FaiCmg to p�oteCt ground weter ❑Not in oomplianc�wIM operating permit
GertifiCation�comp�eed torr„m��$uamnc�to tr,e ro�r�r,�or9o�e�w��m Ts days.�
r nereby ce,vfy fhar aN rhe neoessary rnJbrmeaon hes aeen gaUte�ed to deremdne me c�ompliance sretus af rn,s sysrem. nro
tlet,enrdnetkxrofhrturesystempedarrrance hasbeen norcarr be made du9 to uM�'�Cwn condiQons during sysfem constnrction,
Possi+�le AbtrS6 O(fhe syst�em,irtadequefe mainlertanCe,Ot'flilti/e tvBl+9r usege.
Name: Jose�h J.Olso� CertNk.etlon number, t255
Business Ilcense�an�e and rxuttber: Rusty Olsods 9oI!end P�u1a�n lestin�i L�C�8a0 or
Name ot local unit af govemment: C� of Orv�a
SigneNra: ^�'� _ Date: 6/25l10
Required Attachments �nspedor Cors�pls�:�his Insp�tlon Report��pages long.
CheCk comp1i81�C�fOrntB 4tffiChed: �li�draulic Perfom3anCe 0 T�nk Inte�riiy �Soil SepareNo� �Opersting Pertnit Fortn tl�
appllcabb) ❑Systnm drswinglAs-built brsivvinQ ❑An a�eeaement of any to�t rsqul�rnants that aro dif(erent irom what is requirod on thla
form �50l Horing Lops ❑Abendonme►�tort►+C+�ePProP►�a�1 C��f inf6mfaG6ff�tr
Upqrade Requtrements(derived trom Afrm.StaG§t t5�55)n�r�,r�e�r rn�e.��o puouc neaRn sov arieo�f�r�rs�mosr ne upprecec.repacoa.or
rts w.w000ntnu�ad Nawn ren mwdha or.eoaipt ol Haa noeroe a�dAln s snorlsr pnloa arevw�ed ar�bca��du,arxe.n ene syatem 1a 1pWnQ to a�orea o�ound
wp�er,fhe ayatem muat be uppiaded,reptso9A.a Rs uas atr[ditlr►ued�In t�+o tbno�eQui+ed by bcst aeManoe.Nan ixlmfU+p eyetem ia nof fei�'np ea deRned in
�:aae I►aa at l�ast I�.n Ibef ol0�afpn solssOnsRon,men p�e sY�+�naed rwf ee nppred��ep�roe,�sptet�t0,a Ite use dl�ntirn,e0,noA+�fal►►0�Y
ACB!ol0lnalrce U�et!e mwe 8Md 77+1a plowaion daec iw?apply M syatsma M SAalNand NMs,YVeIA►9ad?ivleciion A�sas.or Naa�uaed!n connedion M7'dr bal,
De►erape,and Indginp e�ments aa defned in bw.
wq•wwists4-3t Ccmplionre IrtspectTon fom►for Ex►sting SSTS
�/4/0B-
. 05%25/2010 12:18 7634988290 RUSTYS PERC TESTING PAGE 04
Parcel number: SyMem Stetus: �CorrapliaM ❑Noncomplla(ii
(es deiemri»ed by thfs fia/m)
Hydraultc P�rtom+a�ec� and Other Complianc�
£o�ptia�e�e l�saee#'� �€4
Date af obser�atlon: 527I10 R�6on for ebsenation- PropeRY T►ansfer_
This form expi►es vpon nent inspe�t�vr+or ir���rse yeata��ever ncuxs llraL' SJ21/13
Compfiance questions/c�{tar1A: (Requirecn Ve�ffic�atforr Methdd':(Optione9
Chedc the a m riate bo (Check the appiopiiate box)
Does ths system discharge sewege to the []Yes �No � Searched for surfac;e oudet
und sutfac:e?
Q performed hydraul'�c test
Does�e system discharge sewage to draM ❑Yes �No
tile or su�face waters2 � Searrhed for BeeP�ng in yard
Does the system�use sewege backup ❑Yes �No � Checked for backup i►t home
iata dw�eNi or estaW�shmenC� _ � ���po�ding i�soii system/D-boxea
Do other eituatiw�s e�ast thet hava the ❑Yea �No ❑ Homeowner teatimo�y
poter►tlal to immediately and adversely
{nspect or threaterr publlc health or safely I ❑ Exemined for surging in tank
�el�dric�� unsefe oovers,etc.)? ❑ Bladc soil"Hbove sdl d�spersal system
Anr"�s'aRSNre�/nd/Cptas fhYt L►w aysEe►r►fs en ImI1H�aItt
�rest to pubUc haalth atrd sufee�r. ❑ ���Q��+����P�p��9
❑ Pertortned dye tesi
Does the system pose a threat to ground ❑Yes �No � ��.
water ior any conditia�s deemed non-
xGve as determined b the in
rtY9S��lndicstes thar tho syslam!a fiilirry to prot�t
g►rwnd w�SPr.If"yes';de�sCrfbp thrsondlNon rtoE9d:
'No stendard protocd exists.This I'�St ls not exhaustive,
--- ._------ -- - ._ in sequen6a/onter,,ior doea if�cat�whictr
camarnedons aie necessery ro rr�ake m►s detem',ine6or►.
Certification
This form is to be compleled aM!�d to the Summary FOrm ot ihe Minnesota Poltution Control Agency's(MPCA)Comptiancs
tnsp�ctlo�Form for Exts�n�8ubeurtsCe Srw�geTieatrnsrlt Syslsms.Observetion�,interp�+e�ta4ions,and oondusfons mqst be
oass9P�eled bY art k�pe�.Cflrtiple4a�tv�+�ays4�e subrr�tteA ta�ae lec�!ua1!af eove�nmetad�aifbin 15�a�s.
Prvp�rtg own�c►ame(s}: Kekh Fri�e
Prapert�*addreaa: 7.5t5�Cvarmvsidgflrive,Orono MN 5535�
PropeAy owners adCress('�►dNhroM):
Cou�ty: Hen�eD�n Phone: 882-�476-8703
r t�e,�ar ce►vh-mat�personeuy mede me oaservaao»s.Uteip�etefiona,and cw�clusfons ieported on diis�orm and fhatflrey ars
�►�t
Name� Joseph J.Olsori Ceri�ficetion rnimber. 1255
8ctsinese�1�oer�se r�a�e ar�A r�ua�: R�ty Alaar�'s soit and�e�fia�D�iic#s» ar
Name of Iocal unit f g C' of Orvno
Signature: Date: 5I25110
wq-ww�sts43 f Canp[ionce lnspection Form for FxIsNlrg SSTS
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05i25/2010 12:18 7634988290 RUSTYS PERC TESTING PAGE 05
. P����y�: _ _ System status: �Complie�nE ❑No�compliaM
(as detem+ined by this fiorm)
Tank tnt�g�ity and 8sfety Comp1[snc�
Ee�B �ssu�#2-of 4
pate of observati�on: 5R1/10 Reason for obeelvatio�: _ProPertY Transt�
�ftis fiv�tex�ine�cxt(�9e�): 5/2'�113
Compliance quesdonslcriterla:(Reaulrad) VarHication Mttl►od"': (Opuonel)
Checic(he a riate box (ChecYc fhe apprapriate box)
Dces t1�e system oonaiat of a seePage Pit', ❑Yea �No ❑ Probed tank bottnm
cess I. II w leachin it?
Do eny sewaQe tank(a)leek belvw thei� ❑YeS �No ❑ O�enred Iow Iiq�Id level
desi ned ratk� de th? � F�aamined cAnstructlan�ecords
If yes,identify which sewege � Examined empty(p�rtpad)t8nk
tank leaks, p Probed outside tank tor w�adc soil'
,4ryr�yra"pnswvr indkatQs th�t tl�s s��a�to p�vesct � Pfese�A�E�ua��
gr�und wn+tsr.
� Other Ende Se�t(c seryice----. _.
' Seepage pits meeting TOBU.2550 may be comp�lant lf allowed
in or�nanbe tsy icscal�tmiHirtg atMortty. ---�
"No sf&ndeld p/ptocd exist8. TT7is 1Jst is not exhaustive,in
abQua�e!oide/ ►wi dbes�indlcete wlrich co+nbf»ate�ns
ere�neceassrpto rsoakeN:iadete�ir+e&or�.
Sa�fety Check
1. Ane anr main�enance bale�ouara�lamapa0.craciced.or�pnaired to�e atructurally unsaund� ❑Yes* �No
2. Were all malntenance hole cove�a raptsced in a sxured manner(e.g.,all acrews replaced}? �Yes ❑No'
3. Waa seoondary acoeea teetreint p�ese�+t(ssfety pan,second cover�or safety netting)—high�r recommes►tled. ❑Y88 �No
4. Was any other Batatyfheafth isaue pTeserrt? ❑Yes` �No
E�lain;
`Sysl�rn!�an lmminon!threat to pab/k i�a+lth ind safe!!Y.
�ertifitaEicn
This fomi is to ba oompleted and ettsched to tha Summary Fprm of the Mnnesota PoNution Control Agencr's(MPCA)Compllance
��spec�on Fonn for E�dsBn�$t�l�u�iaee Sevrage T�eabt5srit Sysbmt�.Obaervat�o7ts,irttYerpiatatlons,and conclus�ons must be
c�le�d Et�/en ar�s�x,�eiflE�.�se►v6ee{x�er.�aaspleted fi�s�st be.submitted?a 1he local unit of govemmerrt within �
15 days.
PrvpcKty otivner nae�fsy. Keilt+Fritse
Proparty eddr�ss: , 2�15�cx,nCY�de Dr�ve Or�no MN 5535�6
PropeRy owner3 address(�f di9ie�r►t);
Cou►ri�r: Hennepin Phone: 952�7&9�03
I hereby ceti/y tAat l personatly made the oDsenralior+s, interprefetiwrs, a»d tonCltrs�ons►epnifedon fhis fom►end fiiaf ffrey ere
onnact.
Name: JoS�bn J.DI3bn Certifiw�ti�arr rtamber= �t255r
Businea I�se name arW number: Rushr Olsorf's sail entt paradelion�l:ic�814 or
Neme of local unit mmenk City of Orono
Signgtu[e. Daie: 5/25110
wq-ww[stsq.31 tompllcncc Inspection form for Existing SSTS
4/4/O�
05�25/2010 12_18 7634988290 RUSTYS PERC TESTIN6 PAGE 06
Paroe►number. Systam stetus: �Compllant ❑Noncomptiant
(qg de(�msirrsd by fhis fo►m)
Soil Sepantlon GomPflance snd Other CornPlfance _
�pl�aace tssue�t3 �4
Date of obee�vation_ 5l2V10 Reason for obaen8don: Transf�
Thfa�nn ihis fon►►doea not explre.
Complianca qu�stlonsMMtor1�:(Required) Veriflcadon Method"':(OptioneF)
(Clrack the aPP�Pdate boxl �chedc n,e a�ranna�e boxJ
Fo�systems bulH prior to Apol 1, 1986.and not � Conducted aoil obsarvation(s)(attac:h Doring log�}
Iocatad in Shorols�d ar Wellheed Protectlon
Area or not 8erving e food,be►�erege or ❑ Two provivus verifica6ons(eltach borl�g I�gs)
bdging est8bflshmer�t: ❑ Other.
Doe6 the eystem heve et bast a two-fool
vertical separation distance from periodic:ally
setureted sa�or bedrodc7 Yes ❑No
For non-perforrnance sYstems built Aprll 1.
1985,or Iate.�or for non-pertormanoe systams 5011 OD88(VB�fOf1 d09$f101 EXplf9.PC@Vi0U6 Ob8Bfv8lbR9
tvcaded in SNoreland or WeHheed Protedion �������t��ara sufficieM,unless site
Areas or serving a iaod,beverage or lodging oon�tions have been alteted.
eateblishmant:
poes the system have a three-Mot vertica►
separadon diatartce from pe�adfcally seturated
soil or bed�ock?" Yes No
For reduced separetion dstanCe systems(i.e.,
'perf�rmsnce'systems undar old 708Q.0178 or ' �Y�►sduced by up to f 5 pe�ent!f a/lowed in lOcal
TYpe IV or V uystem under new 7080.2350 or Wd�neRce.
7080.240a): "No standard protacd exists This Irsc is not exhausdve,
Does tt�e system meet th8 4e9igned vertical in aeque►t6a/o�der,nol does if Jpdicete whidt
separation distance from periodlcslly setureted Car►binatians ars n9cesserY b make this
soB or bedrodc?' ❑Yea No ���Ae��
AI�y"no"an�sw�r indJut�►s tMt dw syatem/s f+ping t�pivtoc!
gl+OU►►d W�a�
CertiffcatiOn
This form is to be completed end atted�ed to the Summary Form of the Minnesota Poqution Controi Agency's(MPCA)Compllance
fe►spectlon Form for Exlsfing Subsurface 8ewt�gA Troabne�rt Sysbems.Ob88nretbns,irt�erpretstions,and conclusioi�s inus4 b�
�bY�TM�P�"���-Completed#�EntrsE be sabaAi�teA!o tRe beal�t�t gaveururenl�vlfhin 15 da�fs.
Prvperty owner nan5e{ay: KeiNi Ffitte
Property address: �v�i��ounfrYaide 6rive.Qrono K�[Ft 5�b3�6
Property owners addresa('rt ailt�q:
C� }{�p;rt Pttorie: '952-N8-97A�
f heieby ceti/y fhet I personaN}'mad6!he observeilorrs;interpretaGons;snd conclusiorrs�ported orr�hrs fomt anc�N►at they a►e
� .
Name: Joseph J Olson Certi�6on number: 1255
Business ti�anse name and number. Rtt�tY()taon's svit anc#penxiletbr►�9 Uc�810 or
Name of iqcal unk ' of Orvno
Sign�g: Date: 5l25110
wq-wwtsW-31 Comp(iance lnspectlon Form jor fxist)ng�
4!4lQD
05i25/2010 12:18 7634988290 RUSTYS PERC TESTING PAGE 07
Laas_ �S �BoAns�s
Licenss x81 D
Loca!(oa oc Pra�ecL• 2515 Cvcmt�rside Drive
BQr[rrgs mads by: Rvsty/Olsoo's SoR s��d Perc testing 61Z1/2070
Clsasfffcat�n System: 1kAtSH4 ; �SE�S-�1SE�-SGS � � L�+a�lled ;flther
Auger used(check two):H�nd l�_,or Povr�r_,FIlQht,6ackst or Probe_.,_X�
�anch_msck le_top_vf E�l�e_nE concrrt�e sfs5.Etv.-400 QO�unre�
Boring Number_1�Surface elevation_97,9� Mottled Soil at„1.1_feet
0"-8"Dar1c brown loam t 0yr3/2 N20 present at XY
B"-1A"$rvwn loam 10yr4/4
14"-24"Rusty brown loam 10yr5/3
TBM: Top of lift stafion manhole cover Elv,-100.D0 assumed
Original soil und�the rockbed north side Elv.-99.5
Original soil under the rodcbed 5�outh side Elv.-98.5
Boitom cf rocic bed Elv.-100.7
There is12 ta 2.2 feet of sand under the rockbeC
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,
. Ende Septic Service
� ,� 24910 Territorial Road
Rogers, MN 55374
_ _ Phone: 763-428-4489
;>-
!::
� INSPECTION
F-..
i`
`� DATE, �- �- �-- � � .
t:.._:
?";- :NAME { � i �� 2_
��i �v� r,
�: , � �
;: -ADDRESS � � ; S �;,� n��., i�� ;i:�
F:. :_ i .
CITY -��„�., � STATE �,�. ;�i . ZIP =l7
. E:.
- SEPTICTANK INSPECTION FORM:
�,
[!'
. C: �
Number of Tanks:� Gal/Tank: � � r, �°�:� ",
r;� Type of System: Mound :� Trench Other
. k: Cement Bottom: Yes � � No
Baffles in Piace: Yes :� No
' j
- Watertight: � Yes �'� No
\
�- Water Level Good: Yes %�' No
�. ,
� � `' Tanks meet township & courL,�equirements: Yes'� No
' Comments:
. �=
�; �--.. _
= Signed BY: �� � �af'�� _ � ,? � ;y'
03/04/2015 13:58 9528733112 PAGE 01/a4
�,� Minnesota Pviluti�n �prp �ldi'1G� �I"1S ection Farm
�-=- Contra! Agency p p
524 Lafayette Road Warzi, Existing Subsur#�o� Sewage Treatment Sy�t�ms (sST3�
St.Pavl,MN 55155-d194 Doc 7Ype:Comp!lanca and EnforCement
InSp�GtYon �esults b25Ad on Minnesota PolluNon Contro)Agancy(MPCA) For local tracking purposes:
requirements and attached forms—additional local requlremenis may also apply. (�ii-.;� 0 4 201 a
Submit nompleted forrn to LoC�I Unit of Governmerit(LUG)and ayst�m owner
withln 15 days �t4 � ^� ����V'
System 5tatus
3yst�m status on date(mm/ddFyyyy): 3/3/2015
�( Compliant— Certificate of Complfance � Noncompliant — Notice of Na�lcomp{�ance
(Valia'for 3 years from report date, unJass shorter time (See Upgrade Requirements on page 3.)
frame outNnecY rn Loca!drdinance.)
R�asan(s)for nonaompliance{check all appllca8lel
❑ImpaCt on PubliC Health (Gompliance Componen€�'l)—Imminent threat to pub!!c fiealth and saf�fy
❑ Other ComplipnCA Conditions(Compliarrce Compon9nt#3)�Imminent fhreat to public hgalfh and safety
❑7ank Integrit�+(Compliance Gomponent�+2)—Failing to profsct groundwar�r
❑bther CompHance Conditions(Compliance Component�3)—F�fling to pratect groundwafa�
�]Sc�ll Separatian (Complianc�Componant#4)—�ai�ing fr protect groundwater
� Operating permit/monitoring plan requirements(Cor»pliance Componenl�5)—Noncompliant
Property Information parcel ID#nr Sec/Twp/Range:
Property address: 2515 Count Side Drive-Orvno F�eason for inspection: 5ale
Prpparty owner: Chris Kahler Owner's phone; 952-928-9559 ___
or
Owner's representatl�e: Representative phone:
Local regufatory authority „CitY _ Regulatory authprity phone:
Brief system description: 1250&1000 gallon septic tanks& 1250 gal pump tank 8�_Mound System
Cnmments or recommendatlons:
System does npt ha�e an High Level Ala�m fvr khe pump tank, Needs to have one instalEed to be code compliant
Cert9flcation
I hereby Cerliiy�hat aJl the necessary informatron has been gafhered to defermine the Compliance status of this system. No
deferminatian of fuf�re system pertormance has been r,or can be made dua to unknown condltlons dunng systam constructron,
possible abus�ot�he system, inadequate mainrenance, or future water usage.
Inspector name: Josh Swedlund Certificatian numb�r G1659
Business nam2: Swr�dlun Ic S ice License number: 2502
mspector signature� Phone number: 852-873-3292 ____
Necessary or� Ldc lly Required Attachments
�Sail boring logs �System/As-built drawing �Forms p�r local ordinance
[�Other informatron (list):
www.pCd.StdCe.mn.us • 657-296-8300 • 800-657-3864 . TTY 651-Z82-5332 or 800•b57-3864 • Avdildble in attemaClve formats
wq•wwists4-31 • 3/16J 12 Page 7 of 3
63/04/2015 13:58 9528733112 PAGE 02/64
Property address: 2515 Country Side Drive-Or�no Inspector initialslDate. JS 3/3/2015
(mm/dd�yyyyJ
1. Impact on Public Health—Compliance component #1 of 5
Complfanae criter�a: , Verlfication rr�ethod(s):
System dfscharges sewage to ihe ❑Yes � No �Searched?or surface outlet
�ground surface. � Searched for seeping in yard/backup in home
System discharges sewage to drain []Yes � No ❑ Excessiva ponding in sail system/D-box�s
tile or surface waters_ �Homeowner t�stimony (See Gommenrs/�xplananon)
System aauses sewage backup into ❑Yes � No �"Black soiP'above soil dispersal syst�m
dwelling or establishm9nt. ❑System requires"emergency"pumping
A�ty"yes"answer sbove indiCetes fhe Q Performed dye test
syst�m is an fmmin�nt threat to publiC ❑ �nable to verify(See comments/Exp�anarron)
heaJih�rtd sa�ety.
❑Other Methads not listed (See Comme»ts/Explanatlon)
Comm�nis/Explanatlan�
2. Tank Integrity-� Compliance component#2 of 5
Com liance cri#eri�: Yeriticatipn m�thod(s);
System consists af a seepage pit, ❑Yes � No � Probed tank(s)bottom
cesspool,drywell, or leaching pi#.
❑ Examined constructlon records
Seepage prts meeting 708q.255o may be ❑ Examined Tank Integrity Form (Attach)
Com liant If allowed in loC&J ordl�ance_
❑Observed flquid le�el belaw operatfng depth
Sewage tank(S)leak below their ❑ Yes � N� �Examin�d empty(pumped)tanks(s)
designed vperating depth. �
If yes,which sewage tank(s)I�aks: I ❑ Probed outside t8nk(s)for°black soif"
�I7}I ")/195"answer above indfcafes the �Unable to verify(See Camments/Explanafion)
system is fairing�to prot�ct groundwater. ❑�th�r mQ#hods noi Ilsted (See Gomments/Expl�rfetion)
Cor�ments/Explan etf o n:
3. Other Corllplian�e Cvnditions-Compliance component#3 of 5
a. Maintenance hole covers are darnaged,crackad,unsecured,or appear to be structurally unsound. ❑Yes" �No ❑Unknown
b_ Other issues(e�ectrical hazards,etc.)to immed�ately and adversely impact public heafth or safety. ❑Yes'` �No [] Unknovm
*&ystem Fs an fmminent thr�at ro puWlc health and safety.
Explain:
c. System is non•protgctive of ground waterfor other condltions as determined by inspectar. [a Y�s• �No
"�yst�m fs laUfrtg ta protect groundwater
Explain:
wv�nv.pcascace.mn.us • 651-z96•6300 • 500-657-3864 • TTY 651-282-5332 or BOQ-&57•3864 � dvaiiabEe in altemative fOrmatS
wq-wwfsts4-31 - 31'16/12 Page Y oj 3
03/04/2015 13: 58 9528733112 PAGE 03/04
�
�rop�rry address: 2515 Count 51de qrive-Orono Inspe�tor initialsJDate: JS 3/3/2014
� (mm/dd/yyyyJ
4. Soil Se aratior�— Compliance component#4 of 5
Dafie oF installatlon: 5/1/1984 [] Unknown Veri#ication metk�od(s):
(mmiddipyyy) Sor'1 observafiDn daes not expir�s. Prevtous sorl
Shoreland/Welihead proteetlonJFood be�e�age � Yes � No ebservafions by two independent partres are suHicient,
lodgfng? unless sii�R Conditlons hav�be�n altered or IoCal
Com li�nce criterla: requirements differ.
For sysfems built prior to Apr/l T, 1986, ar�d �Yes 0 NO �Conducted sail observatian(s)(Attaclt boring/ogs)
not locsted in Shonsland or WeUhead 0 Twp previous verifiCations(Attacn bo+�ng loys)
Profection Ar9�or not serving a foorJ,
beverage or lodging estabflshment: I �] Not applicable (Holding tank(s),no d�alnfie�d)
Drainfield has at teast a Ywo-foot vert��al [�Unable to verify(See Commanrs/Explanat;on)
separation distance from periodically ❑ pther(See Comments/Explanatron)
saturated soil or bedrock,
Non-parfarmance systems built Apn! 1, I ❑ Yes ❑No CommentslExplanation:
1996,or later or lor non-performance Boring:
Systems Jocated in ShorAland or WelJhead
Arotectfon Areas or Serving a food, 1-9" 10YR 212 Loam
beverage, or lodgir+g�stablrshment:
10-24" 10YR 4/4 Clay I�oarn
Draintield has a three-foot vertical
separatlon distance from periodlcally No Motts
saturated soil or bedrack.�'
"Experiment�l", "Other;or "Pertormance' ❑ Yes ❑No Irldicat� dQp#hs or elevations
systems built under pre-2008 Aules; Type IV
or V systems built under2008 Au18S(7080. A. Bottom af distribut'ion medla I plus 12"or more
235n or 7080.2400 (Advanced Inspector �
License required) B. Perfodlcall saturated SOflPoedrock I over 24"
Drainfi�ld meets the designed�ertical C. Svstem separation 36"plus
separation distance from periodically "'�" —
satura,t�d sqil or bedrock. , p. Requlred compliance se aratlon' 24"
ARY "no"answe�'above indicat�s tl�e system is 'May be reducBd up to 15 percent if allowed by Local
faflfng to proteaf groundwat�r. Ordinance,
5. Operati�n� Permit and Nitrogen BMP'�T Compliance component#5 of 5 �Not applicable
Is the system operated under an Opera#ing Permit7 0 Yes []No If"yes",A below is requfred
Is the system naquired to employ a Nitrogen BMP7 ❑ YeS ❑ No If"`yes", B b�low is required
BMP=Best M�nagement Practrce(s)sp9cified in the system das�gn
!f the answer to both questions 1s "no°; this section does nof n�ed io be co►npleted.
Compliance crlterla __
a, Operating Permit numbec= 0 Yes ❑ No
Have the Qp9rating Permit re uiremsnts been met?
b. IS the requlred nitrogen BMP in_place and properly funCtioni�7 ❑Yes [�No____�
,A,ny "no"answer I�dicate�Nancomplfance.
Upgt'ede�tequirements(Mfrtn.Stxt. §915,55)A»�mmin�nt threat to publ�heafth and sal�ty(lTPHS)must be upgradad, replacod,or its use
dlsconttnued witY�r17 tEn InOnihs o/racefp!of this rtofiCe or wr7hln a shortarperfod if fE+quil'ed by IPGa!ordlnance, !l the sysfER1 is idiling to proiect
ground wafer,the sysiPm mUst b9 upgraded,replaced,or its use dlsconrinued wlthrn the time required by local ordinance.If an exrsti»g system
rs not faf7ing as deffned in law,&nd h�5 At leasl nvo feet of desrgn sor!Separatron,therr!he system need not be upgrdded,repalred,replaced, or
rts uee dJ�conNnued,nofw�thstanding any local or�lnanca[hat Is more striCt. Thrs provfsr'on do�s not apply to systems rn shpreland ar�as,
WellhBad Protectlon AreaS,or tftose used in Connec8on wlth food,beverage,&»d lodging establlsltmenfs as defined rn l8w.
www.pca.sta[.e.mn.us • 651•296•6306 • 800,657-3864 • TlY 651-28Z-533Z or 804•857,3864 • Available in altemative formats
wq-wwists4-31 • 3116/71 Page 3 of 3
03/04/2015 13:58 9528733112 PAGE 04/04
Swedlund Se�ptic Services, Ir�c.
25648-�240�"Street•Belle Plai�,e,NIN 56411
952-873-3292 ,
Josh J.Swedlund Lic.#�2502
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Date: � '� � �`�J
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�'�' �y, , �, !I Municipa( Offices
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� '�� ' �� G " Street Address: `�5a-a4 q'y 6� � Mailing Address:
��`�kE8Hpg'� � 2750 Kelley Parkway P.O. Box 66
: Orono, MN 55356 Crystal Bay, MN 55323-0066
To Current Owner: Address: �� �S �C �^���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.
SYSTEM CONFORMITY (1-3): �
rl�`CODE SYSTEM" An ISTS which meets all the location,design and construction standards ofthe current Orono Municipal Code.
�J
2 `CONIPLIANT SYSTEM" An ISTS which does not meet all the location,design and construction 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 standards of the current Orono Municipa]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): `C�
Tank inspection indicates:
5 Pumpout not needed at this time.
�Septic tanks must be pumped out this year (city code recommends tanks to be pumped out once every 3 years.
Tank was last pumped )•
Make sure septic tanks are pumped through manhole and not through white inspection pipes. This allows for the proper
cleaning Keep water softner and iron filter discharge out of septic system to prolong life of drainfield. Ask pumper to test
alarm float to verify alarm is still working in your house. The alarm warns owner that septaQe is about to backup into basement.
7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank. If
tanks have not been pumped out within the last three years,they should be pumped out now.
D INFIELD CONDITION(8-10): b
8 Drainfield is dry,no surfacin�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 ck5 �K-- - t' u � 5 c �-: � '��.��C�
�� ,�,,�� v� Y��T �,:��, �� ...��� .�7r���. 1��T 3 yt��S ;
�-7.`\-0� ��� �
Date of Inspection Matt Bolterman - Septic System Inspector
Note: In the event that this inspection report is used to sa[isfy 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.
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���;�;�;;-,O�g�iG " Street Address: Mailing Addreu:
�'$�I 2150 Kelley Parkway P.O. Bax 66
Orono, MN 55356 Crystal Bay, MN 55323•0066
95d-�4q-y600
To Current Owner: Address: a S �S �c?u�T r�!5;c�C D�,
City Ordinance 199 requires fhat each existin�on-site sewage treatment system in Orono be inspected every two years.
The on-site sewa�e treatment system at the above address has been inspected and appears to fall into the categories checked below.
SYSTEM CONFORMITY (1-31: �
�"CODE SYSTEM"An ISTS which meets all the location,dcsign and construction standards of the current Orono hiunicipal Code.
L/'�COI�IPLIANT SYSTEM" An ISTS which does not mect all the location,design and construction standards of the current Orono Municipal
Code but docs meet the three foot scparation requirement or two foot requirement for systems installed 1996 or eaziier,and which is not failing or
an immincnt threat to pubiic health or safcry.
3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designatcd 100-year flood plain,any ISTS which may
or may not meet all thc location,desion,or conswction standards of 4he cumnt Orono Niunicipa]Codc and which is failing for any reason;and
any ISTS with Iess than tfuee feet of unsaturated soil or sand between the distribution device and the limidng soil characteristics.
TANK CONDITION(5.7�: �
Tank inspection indicates: .
5 Pumpout not needed at this time.
6 Septic tanks must be pumped out this year (city code requires tanks to be pumped out once every 3 years.
�` Tank was last pumped 11-�-'-i -0�� ).
N1ake sure septic tanks are pumped throuEh manhole and not through white insnection pipes
This al]orvs for the proper cteanino.
( 7 ) Inspection risers missin�tanks could not be inspected. Inspection risers(4"dia.pipe)must be instalIed in each tank.
�J
DRAINFIELD CONDITION($-�Q): �
� Drainfield is dry,no surfacing evident.
9 Some evidence of surfacin�,not critical yet. '
10 Drainfield is saturated and visibly dischar�in�untreated effluent to L`�e surface. Contact the City Inspector
immediately.Repairs must be completed within 90 days.
COivfi�NTS: S�S� e� �o�k5 b� , Ne�� ��.5e� o � �`.rS�- �-qn`�
�v C�O p���CC' ic����� �-;cc-� . pvr,l� .�--af-.\L5 61e�'1- �/2GC' .
� � — 0� �`n�a,-� —
Date of Inspection hiatt Bolterman- Septic Sysiem Inspector
Note: In the event that this inspection report is used to satisfy the rcquircmenes for a mort;age or other transfer of properry,be advised thai this report does not guaranca
or certify that an existing system will continue W function properly,but is merely an opinion of the adequacy of the system under current conditions bised on the available
infarsnation.
- — _ �
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� ���:���������r�;��.�. � � �, ��� CITY of ORONO
� !� ; Municipal Offices
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Street Address: Mailing Address:
�� _ 1tEgg0�,� 2750 Kelley Parkway P.O. Box 66
_- _ -- Orono, MN 55356 Crystal Bay, MN 55323-0066
May 1, 2000
Keith& Kimberly Fritze
2515 Countryside Drive
Long Lake, Mn 55356
Dear Mr. & Mrs. Fritze:
An inspection of your septic system was conducted on Apri125, 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 appro�mate location of the septic system.
If you have any questions regarding this report, please contact me at the City Offices at 249-4600.
Res ectfully
�
�
,�,�I ri.��-C,��
Chris Pence
On-Site Systems Manager
Enclosures
In the event this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,
be advised that this report does no guarantee or certify the 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 the system location and pumping records.
Telephone(952)249-4600 • Fax(952)249-4616
www.ci.orono.mn.us
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" Mailin Address:
\.\ � � dj � � �%
`��� 'C� ��:�'` ' �` ��:��" �;%' Street Address: g
�;� � , � ` � .:' P.O. Box 66
,� <q�Esx�� 2750 Kelley Parkway
��,�� Orono, MN 55356 Crystal Bay, MN 55323-0066
To: The Cunent Owner of Address � � ( � C �% �"����� S.`�P
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 l:nown 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 brought 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 �N�
If yes, system must be brought into compliance by:
December 31, 2007
December 31, 2010
Other
Septic Tank s ump 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
� t�:-j -Cyv . The tanl:(s) should be cleaned through the manhole and
not throu�h the inspection pipes, this allows for proper cleanina.
Comments:
f- �
I������ �� � ' -� !^_
Date of Ins ection `� ��'
Inspector: p
Telephone (:9�2) 249-=3600 • Fa� (9�?1 249-4616
CITY OF ORONO � O�
Municipal Offices O � O
Post Office Box 66
Crystal eay, MN 55323-0066 � � ON-SITE SEWAGE TREATMENT
� � INSPECTION REPORT
�' G~
�9kESH04'�
Owner: f��.l� �1�1�7�� Address: , ��e� r
�
Permit #'s: � Dates: ��o{�� Contractors: �i'�IZ �!� �,
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 [ ] neu 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.
2 "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 uhich
is operating satisfactorily by treating and disposing of the entire current sewage input without discharging
any pollutants into ground or surface uaters.
3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located uithin 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 uith less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soil characteristics.
(The limiting soil characteristic '4(] has or [ ] has not been identified at this time. If the limiting soil
characteristic has not been identyfi�U, this classification may be subject to revision.)
TANK CONDITION (5-10):
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pu�nped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Tanks should be pumped out as soon as possible.
� System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface discharge.
Inspectton risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
tank at next pixnp�ut. If tanks have not been pumped out within the last three years they should be pumped
out now.
10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
If tanks have not been pun�ed out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14):
Dr field inspection indicates:
�Drainfield is dry, no surfacing evident.
^a92 Sane evidence of surfacing, not critical yet.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
irtmediately. Repairs must be canpleted 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.): 1���
COMMENTS: -�
•
Date of Inspection Sept c Sys em 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 prE�nises with the system loc>ti�n 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 a � ON-SITE SEWAGE TREATMENT
r�, � INSPECTION REPORT
'�� G~
�
9kESH�g'
�- �����r� ^ �
Owner: ��GaL�1'� � �)''�1P-5' Address: .�/� � �
Permit #'s: t`���(� Dates:_ �a��r���i�d: Contractors: �ii�Y1'�(�.�7?Y! J'��L;r��
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
uithout discharging any pollutants into ground or surface waters.
2 "CONFORMING SYSTEM"-A system uhich does not meet all the location, design, and construction standards of the
current City Codes, but uas installed according to the code in effect at the time of installation, and uhich
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 [ ] has not been identified at this time. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDITION (5-10): �
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Tanks should be pumped out as soon as possible.
� System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface discharge.
lnspection risers missing-tanks could not be inspecte nspection risers (4" dia._pipe) must be installed in each
tank at next pumpout. If tanks have not been-pump a out witnTn zne-tas�three years, -ttl2y-shaotct-be pumped °
outTtow:--�-----
10 Inspection pipe is located directly over tank baffle <does not give accurate measurement of solids accumulation).
If tanks have not been ptxnped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14):
Dr�ynfield inspection indicates:
(1y 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
irtmediately. 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.): ��J
COMMENTS:
_ � �,� ��
. Date of Inspection e tic Sy em 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 pre�nises with the system loca±ien and p�mping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
On the North Shore of
Lakc Mzrznetonka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
1335 S. Brown Rd.
� � � Crystal Bay, MN 55323
473-7357
OW N E R b�(��Y�.U�Pn � _�
ADDRESS
PERMIT NO.'S. rJ�� DATES b�7 g� CONTRACTORS � •
City Ordinance No. 210 requires that each on-site sewage treatment system in Orono be inspected on a regular basis. he 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)
� � Meets or exceeds current City standards in all respects relating to design,construction,and location.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,construction,or location.Appears to be operating
adequately at this time, but has a relatively high potential for future problems. No major upgrading of system is required at
this time.
� 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 curre�t 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.P�ease contact the City Inspector to discuss system repair/
replacement procedures. If drainfield replacement is necessary, soil testi�g will 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 now.
❑ 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. �tanks have not been pumped ou i immediately.Repairs must be completed within 90 days.
the last three years,they shou pumped out now. � � Drainfield extent and condition unknown.
SITE CHARACTERISTICS:
Limiting Site Factors Potential for System Failure Site Capabilities for
❑ 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 ❑ Inadequate
❑ Drainage ❑ System is causing visible
surface discharge.
COMME TS: � �� � �� e U <� - �G� tY�(
) y 1� � ' L�'7�"/ ' �rl Y_S
%
�oZJ 9/' �...
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
On the North Shore of
Lake Nlinnetonka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
� . � � 1335 S. Brown Rd.
Crystal Bay, MN 55323
473-7357
OWNER . 2���j�✓� �' �Gt�I�C'� 1�,��T�'11�P� ADDRESS �1—� ��1�W�1C11� �/, _
� �,`'���o�
PERMIT NO.'S. �a �� DATES .�l v�� CONTRACTORS
City Ordinance No. 210 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)
�� Meets or exceeds current City standards in atl respects relating to design,construction,and location.Appears to be operating
properly,
� 2 Does not meet all current City standards for new construction (1978 Code1 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, construction, or location.Appears to be operating
adequately at this time, but has a relatively high potential for future problems. No major upgrading of system is required at
this time.
� 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 nuisa�ce.Please contact the City Inspector to discuss system repair/
replacement procedures. If drainfietd replacement is necessary, soil testing will 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 jnspection indicates: ❑ Inspection pipe is located directly over tank baffle. (Dces 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 now.
❑ Solids accumulation i� 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 Capabitities for
❑ Slope (depends on soil types,water Futu e Expansion
❑ Soil table and system condition) ,(� Adequate
❑ High water table �Low ❑ Fair
❑ Lot size ❑ Medium ❑ Poor
❑ Lake,wetland,or stream ❑ High . ❑ Inadequate
❑ Drainage ❑ System is causing visible
surface discharge.
COMMENTS:
�,/� Z ^)
Date of Inspection 9 ptic 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 conditio�s 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