HomeMy WebLinkAboutseptic info /��
,• x �
��
� ����� �}���5��� �'�i������ � �� Compliance Inspection Form
'���, .� �or►�ra)Agen��r
���,��Q�,����, Existing Subsurface Sewage Treatment Systems (SSTS)
5t Paut,Rrt1u s51ss-a19�ct Iristructions on page 7
Parcel number. For Local Tracidng Purposes:
Sys6em status: ❑Compliant ❑Noncompliant
(based on a!!compliance requirements)
Summary Form
Property Information
, Property owner name(s):
Property address: "j���� '- ��/Z� C c4` /t G...�c7 c�r i2 ,
Properly owne►'s address(rF different)_
Courrty:�c:��vfi�i✓ Property owner phone: Permitting authority: � . �a, c9� ���G��Q
—�
Date system constructed: Reason for inspection: ����
System Descripfion
Brief system description:f►j G J,�;��'�S�t�,� �'� �R K,�'�� / -� f� l�� /�v��/�iv��
Local permit number: �r (}� �, Number of bedrooms: �.� Design ftow rate: "Z��7
Is the system:
In Shoreland arsa? ❑Yes [�No In Wellhead Protection Area? ❑Yes �No
An U.S. Environmentai Profiection System serving a Minnesoia Department
Agency(EPA)Class V Injection Well?�Yes �No of Heath(MDH)licensed facility? ❑Yes �No
C0117P�1dhC2 $tdtUS (Based on state requirements-additional local requirements may also apply.)
Based on the information gathered and reporfied on attached forms,the compliance status of this systiam is(check one):
�Cerlificate of Compliance-valid until(3 years fiam date of report):
❑Notice of Noncompliance-For Noncompliantsystems:
The reason fo�noncompliance is:
This noncompliant system is classifled as(check one belowj:
❑Imminent threat fio public health&safiety ❑Failing tio protect ground water ❑Not in compliance with operating permit
C@I"t1f1Cdt101'1(Completsd form must be submitted to the local unit of govemment within 15 days.)
1 hereby certify Ehat a!1 the necessary information has been gathered fo detem►ine the compliance status of this system.No
determination of future system performance has been nor can be made due to unknown conditions during system constniction,
possib/e abuse ofthe system,inadequate maintenance,orfuture waterussge.
Name: �t7/1 C/1/ � �j ���,;��v Cer6fication number. �3' �
Business license name and number. �g j'��.-v �C1�S f `�!L s/J, cJ £iz.ay�t�,� �1/ or
Name of lopl unit of govemment ; �� /���i/�%
....-.�
Signature: •' G�,,� Date: � � /zi
Required Attachments Inspector Complete:This Inspection Report is�pages long.
Check compliance forms attached: �(Hydraulic Performance �Tank Integrity �j Soil Separation ❑pperating Permit Form(if
appficaUle) ❑System drawino/fis-buift drawina ❑An assessmenf oi any focal requirements thaT are different from�nihaf is required on ihis
i)''Itl i� ,il� i�l"i�l(� ...%,rc I i i".I?,-1'.'�)fi L,it i� - .�i�il �-,�.,��t;:'.el _ �'�G.I�.-� '-,�I�.�.i ��,..,�:
._— — ..i] . _.— . _ '. . __—..�.,n:,7� ,�.c.,�. �l.d�. .�'�il �.L ...8�i �� ; �bi L.T��r�..�ti� . -_���.....�U;. _—
its use di:�aiiinuecl�-vit,`�in ten monri�s o�`rec eipt ui rhrs noiice ur vvrfhin a siiater pened ii iaiuir�l by Iecal aJinance.!i the system is iailrny to p�cieci`yrcwnd
wafer,the system must be upgraded,replaced,or its use discontinued within the h'me required by fecal oirlinance.If an existing system is rrot failing as defined in
law,and has at least(wo feet of destgn sdl separation,then the system tte�d not be upgraderl,repaired,replaced,or its use dlscontinueci,notwrthstandirg any
local ordinanc�that is more stnct rhrs provisron does not apply to systems in shoreland araas,Wellhead Protection Areas,or those used in aonnection witl�faod,
beverage,and lodgfng�blfshments as defrn�ed in law.
wq-wwists4-31 Comp(i�ce Inspection Form for Existing SSTS
4/1/08
Parcel number: System status: (�Compliant ❑Noncompliant
(as determined by this form)
Hydraulic Performance and Other Compliance
Compliance Issue #1 of 4
Date of observation: Reason for observation: SZ ��
This form expires upon next inspection or in three years,whichever occurs first:
Compliance questions/criteria: (Required) Verification Method*:(Optional)
Check the a ro riate box (Check the appropriate box)
Does the system discharge sewage to the ❑Yes No
round surFace? � Searched for surface ouUet
� ❑ Performed hydraulic test
Does the system discharge sewage to drain ❑Yes No
file or surface waters? �Searched for seeping in yard
Does the system cause sewage backup ❑Yes �No ❑ Checked for backup in home
irrto dw�elling or eslablishmenY? [] ���ve ponding in soil system/D-boxes
Do other situations exist that have the ❑Yes �No � Homeowner testimony
potential to immediately and adversely
impact or threaten public health or safety ❑ Examined for surging in tank
electrical,unsafe covers,etc. ?
❑ "Black soil"above soil dispersal system
Any"y�es'°answer indlcates that fhe system is an imm/nenf
threat to publlc health and safety. ❑ System requires"emergency°pumping
❑ Performed dye test
Does the system pose a threat to ground ❑Yes [�No
wafier for any conditions deemed non- ❑ Other:
rotective as determined 6y the ins ector'l
"Yes"lndlcates that fhe system is failing to protect
ground water.If"yes",describe the condition noted:
"No standard protocol exists. This list is not exhausfive,
in sequential order,nor does it indicate which
combinations are necessary fo make this deferminafion.
Certification
This form is to be completed and atlached to the Summary Form ofthe Minnesota Pollu6on Control P�qency's(MPCA)Compllance
Inspection Form for Existlng Subsurface Sewage Treatment 3ysbems.Observafions, interpretations,and conclusions must be
completed by an inspector.Completed form must be submitted to the local unit of govemment within 15 days.
Property owner name(s):
Property address: �7�� '- ( lL �' C,� �L��J c)�✓� �-�L
Property owner's address(�f different):
County: 1 � ;� �v,�t1� ,� Phone:
/
l here6y ce�tify that I personaHy made fhe obseivafions,interpretaSons,and conclusions iaported on fhis form snd fhat they sre
correct.
�lame� ��jV � ��L,-T� Certification number: � �,��
;� : _.. , 1 -- -- -+—� ----
. . � t ir,=:.:i�; Ir..�i� �lil;:'.�:I�: y'YV '�' __�A,r� ._�/�l, y �... ./ Ni�nr �_�iLal� C'-�'' •!'-_ 't�
___- i
- ^ ._ _ � _.__._ ___ ._ __-_
. . . .. . . , . , . ._ 1 F- l/ /C��/Q , __-__. _.__
Signaiure: (�-v, Date: ��i L
wq-wwists4-31 Comp(iance lnspection Form for Existing 5573
4/1/08
Parcei number_ System status: (�Compiiant ❑Noncompfiant
�as determine��r��so�m���=���=J�,Le � - .
�v-3`E"i4�i:�i ir'i. ivti�. �
Si. Michael, MN�5��6 : .
Tank Integrity and Safety Gompliance .
Comptiance Issue#2 of�4 �
Date of obsecvation: �- o�1 Z Reason for observafian: S i II��^
This form expires on(three years):� � SS l S
Compiiance c}uestions/crit�ria: (Required) Ver�cation Method'Y:�(Optional) .
Check the a ro riate box (Che fhe appropriate b6x)
Does the system consist of a-sespage pi#', ❑Yes No Probed tank bottorri
cess ool d eil,or�leachin it? ❑ Observed iow Iiquid levei -
Da any sewage iank(s)leak below their ❑Yes No � �amined construction records . � �
desi ned o eratin de th? :
[�F�camined empty(pumped)tank
If yes,identify which sewage . . .
tank leaks. � 0 Probed outside tank for"black soil'
Any"yes"answer ind/cates that the syslem is failing fo proiect (] Pressurelvacuum check
ground water.
� ❑ Other.
t Seepage pits meeting 7080.2550 may be compliant if altowed -
in ordinance by local permitting�authoriry. � _
"'No standard protoco!exisfs. This list is not exhauslive,in� :
� sequendal order, nor does it indicate which combinaBons _
are necessary to make.this determination.
: Safety Check _ .
0Y s`. ' �NO�
1. Are any maintenance hole covers damaged,-cracked,or appeared to be structurally unsound3 _
2. Were all•maintenance hole covers replaced in a secured manner(e:g.;all-screws reptaced)?
y ❑No*_
3. Was secondary access restraint present(safety Fan;second cover,or safety netting)—highly recommended_ Yes ❑No
- ❑Yes' L�No
4. Was any other safety/health issue present7 �
Explain: � -
xSystem is an imminent threat to public heattfi and safety.
Certification . �
This form is to be completed and attached to the Summary Forrr►of.the Minnesata Pollution Confrol Agency's(MPCA)-Compltance
lnspection Form for Extsting Subsurface Sewage�Treatment Systems.Observations,interpretations,and conctusions must be •
completed by an inspector,maintainer,or service provider.Completed form must be submitted to the locat unit of gavemment within
15 days_ 1 .
Property owner nams{s): - �
Property address: L/ 0�� � �'Zc t�w�� d �� �� . •
Property owne�s address(if d'rffarent): -
County: Y�I N� <<�' --�-� Phone:
!hereby cerfify that(pe�sonatly made fhe observations,interpretetions, and conclusions reported on fhis form antJ that theY are
correct. �
Certfication number. �� � �� �� .
Name: J � �� � � C� i'' . t� .
` �T{-� _ �'t �' ,�, Li��' " IG -J Gl or
Business license name and numbec _(�t i(��'I��� ' .
Name of loca!un avemment: � �_r � •
Date_
Signature: . �
..._ .._..:_._� �,�
LomDtianc8lnsnectfan Form for Existin8 SSTS
Parcel number: System status: �Compliant ❑Noncompliant
(as determined by fhis form)
Soil Separation Compliance and Other Compliance
Compiiance Issue #3 of 4
Date of observation: .3 Reason for observation: S��t
This information on this form oes not expire.
Compliance questions/criteria: (Required) Verification Methoc!**:(optional)
Check the a ro rrate box (Check the appropriate box)
For systems built prior to April 1, 1996,and not [� Conducted soil observation(s)(attach boring logs)
located in Shoreland or Wellhead Protection
Area or not serving a food,beverage or ❑ Two previous verifications(attach boring logs)
lodging establishment:
❑ ome�: �.p _ ic':,,�, 1 j�
Does the system have at least a two-foot
verticai separation distance from periodically '��--� '- '� '�J 4ti-�r
saturated soil or bedroclC.� �Yes ❑No 7�'��dx Q� �S'
For non-pertormance systems built April 1,
1996,or later or for non-performance systems
located in Shoreland or UVellhead Protection Soil observation does not expire. Previous observations
Areas or serving a food,beverage or fodging by two independerrt parties are suffiaent,unless sits
establishment: conditions have been altered.
Does the system have a three-foot vertical
separation distance from periodically saturated
soil or bedrock?* Yes ❑No
For reduced separation distance systems(i.e.,
"F>erFormance"systems under old 7080.0179 or " May be reduced by up to 15 percenf if allowed in/ocal
Type IV or V system under new 7080.2350 or ordinance.
7l)80.2400):
*'No standard protocol exisfs. This list is not exhaustive,
D��es the system meet the designed vertical in sequentia!order,nor does it indicate which
se>paration distance from periodically saturated combinations ate necessary to make this
suil or bedrock?* ❑Yes ❑No determinafion.
Any"no"answer lndicates ihaf the system is failing to proteci
ground wate�
CE�rtification
This form is to be completed and attached to the Summary Form of the Minnesota Pollution Contrul Agency's(MPCA)Compliance
Ins pecfion Form for Existing Subsurtace Sewage Treatment Systems.Observations,interpretations,and conciusions must be
cornpleted by an inspector or designer. Completed fnrm must be submitted to the local unit of govemment witt�in 15 days.
Property owner name(s):
Property address: �j/7 CI U � /L t.c-�� (.v c�+c �-� �i1
.
Property owner's address(if different):
Courrty: ����,��`L Phone:
I he,•eby certify that I personally made the obseniations, interpretations, and conclusions reported on this form and fhat they are
correct.
.���I,�=' •i _ .. . � / ��
�z�_ _ll��,r, `� , -.,, , �
--------/�-- -
� -- - - ---
ausi,ass 4c;���a �a�;���n�l�� i��c�a�: /)y� �-,�,�� (.G/G S ' ,��j,� S�t iz v� �.cs-' .�,
�—_---
Name of local unit of govemment � , � � 0��,��
Signature� �,7�_ ��-�'J� Date: v'l/�// ?�
—�_
wq-wwists4-31 Compliance Inspection Form for Existing SSTS
4/1/08
� , , � �
� O`V
O �, O CI'TY OF ORONO
� -
� Muaicipal Offices
a �,
r�,, ,�`�` �, Street Address Mailing Address:
� G'�' 2750 Kelley Parkway P.O. Box 66
'�9 �i Orono, MN 55356 Crystal Bay,MN 55323-0066
kEsHo�
To: The Current Owner of Address 4700 CREEKWOOD TR
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 -hreat
Yes
No
If yes, please contact the Onsite Systems Manager at 954-249-4626 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
No
If yes, system must be brought into compliance by:
December 31, 2007
December 31, 2010
Other
Septic Tank(s) Pump t Needed
Yes
No
The city recommends the septic tank(s) and/or lift tank be serviced and pumped out every three
(3) years. City records indicate the tank(s) were last pumped out on I - �� �c�7
The tank(s) should be cleaned through the manhole and not through the inspection pipes, this
allows for proper cleaning.
Comments:
�.
Inspect��/_'��� Date of Inspection: a ' ��
�
Telephone (952) 249-4600 • Fax (952) 249-4616
www.ci.orono.mn.us
.
, - • -
• • • •
e
To: Orono residents on mound type septic systems
Fmm: Willie Gibbs, ISTS Manager
Date: May 10, 2006
Re: Landscaping Do's and Don'ts for Mound Systems, Quick Reminder
Do plant and maintain a fuU cover of grass and keep mowed to a normal height, this grass cover aids
in the evaporation of large amounts of effluent (the liquid left after the "other" stuff has been removed)
in the summer time and allows the mound system to help breakdown nitrogen in the effluent,
Do water the grass over the mound in extreme dry conditions, sparingly.
Do avoid unnecessary foot traffic over the mound, mow it and stay off of it. This is especialiy true in the
winter time. Even human foot traffic can cause frost to penetrate the mound resulting in potential
freezing problems.
Do inspect your mound system annually for winter kill, (reseed if necessary) animal damage,
(burrowing)or signs of potential failure.
Do not plant trees or shrubs on the mound system, smaller trees and shrubs may be planted at the
edges. Remember,that sunshine is the key to a healthy mound system.
Do ask questions, if you have any concerns or questions concerning your mound systerra
please feel free to call me, !can be reached at 952-249-4626.
1
%
� � ��
� O O�'��
�� ;�,,:� ���:�_ CITY of ORONO
� lkl� /j,C .,, � il
,,�� ���'������, ���; ��� ���I Municipal Offices
, , ,� '� � ���;-� �� Street Address: �15a'a4q'y6o � Mailing Address �
��'`4�'ESK��'� 2750 Kelley Parkway P.O. Box 66
�-_ Orono, MN 55356 Crystal Bay, MN 55323-0066
To Current Owner: Address: � 7C.%� C'��C���-�'�� 1"r
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 CONFORMIT'Y (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 LSTS 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 safety.
3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-yeaz flood plain,any lSTS which may
or may not meet all the location,design,or construction standards 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 distribution device and the limiting 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 recommends tanks to be pumped out once every 3 years.
Tank was last pumped �iC: ��? C'C;�{J ).
Make sure septic tanks are pumped throu�h manhole and not through white inspection pipes. This aliows for the proper
cleaning. Keep water softner and iron filter discharQe out of septic svstem to prolong life of drainfield. Ask pamper to test
alarm float to verifv alarm is still workin�in your house. The alarm warns owner that septa�e 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.
DRAINFIELD CONDITION(8-10): �
8 D.aiaficld is dry,no s,u-facing cvident.
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: 'j�C�t'� Lr� �C_��J n f� ��-}-i L ��-I _� I��L� � f J iJ�S f.'S'
c1� � �1�[� �L���..n�-t ��i S��-1-t�,� — rC� ._C�; -t ���3 I. s c, �"rtA 5�4
�ue''��� �:.'��' �-�r�;���a A� �a �;�:,�t�� �iL� ���� �e �
�, -� - �� �.� ��-
Date of Inspection Septic 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 ciureot
conditions based on the available information.
/ o
,� � �
;- o�:: o
'' ���; =`�� CITY of ORONO
11 . r� '^�8���`" .�n�' !�' P
' ����' f Munici al Offices
� + Ij �
\'��r��,�r��'���ti G
9 '��,�„;r� g.w Street Address: Mailing Address:
�!'�,+gg0 2750 Keiley Paricway P.O. Box 66
Orono, MN 55356 Crystai Bay, MN 55323-0066 �
To Current Owner: Address: 4 7 U U C!t ������ T�q; �
City Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every two years.
The oo-site sewage treatment system at the above address has been inspected and appears to fall into the categories checked below.
SYSTEM CONFORMITY (1-3Y. �
lO "CODE SYS'I'EM" An ISTS 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,design and conswction standazds of the current Orono Municipal
Code but does meet the three foot sepazation requirement 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[STS 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 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 chazacteristics.
TANK CONDITION(5-7): ��
Tank inspection indicates:
� 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 V��c�^� ).
blake sure septic tanks are aumaed throu�h manhole and not throu�h white insnection pines This allows for the
proper cleaning. Keea water softner and iron filter discharge out of septic system.
7 Inspection risers missinb 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.
DRAINFIELD CONDITION 8-10 : �
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.
CONLv1ENTS: I`�o v�c� ��aK-S 0�, P.,��—p S���-�L fi��C S ;� -3'1���/
1�Rv � �� r Se�� p�Mp:� �.��,=�. �q1�- 3 YeScS
� —\� ' U� �''""� f �
Date of Inspectioa Matt Bolterman - Septic 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 thai an existing system will continue to function properly,but is merely an opinion of the adequacy ofthe system under curtent conditions based on the available
infortnation.
Telephone(952)249-4600 • Fax(952)249-4616
www.ci.orono.mn.us
� O�
O ��� O
�-����=� CITY of ORONO
, � ..- -�
r� �'��,���`�+�y �
j�£a✓p
�'� � ����� �����,�r G�� Municipal of�'ices
,� 1��� ��J;`� ,� SVeat Address: MailinQ Address:
`�'�HQ�' 2150 Kelley Pa�iCway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323•0066
Owner: J e0.c� U �� �Or Address: �17U0 ��eek�^-ooJ 'fr_
City Ordinance 199 requires that each existing on-site se�-age 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): �
(L � ��CODE SYSTEM�� An ISTS which meets all the locatioq desigi and coast�uction standards ofthe cutrecrt Orono Municipal Code.
�i
2 "COMPLIANT SYSTEM" An ISTS which does not mut all the location,design and construction standards of ihe cuirent Orono Municipal
Code but does meet the three foot sepazation requiremet�and which is not failing or an imminerrt threat to public health or safety.
3 ��NON-COMPLIANI'SYSTEM" A prohibited ISTS;an LSTS located withirt a designated 100-year flood plain,any ISTS which may
or may not meet all the location,design,or construction standards ofthe aurent Orono Municipal Code and which is failing for any reason;and
any ISTS with less than three feet of unsaturated soil or sand bztween the disYribulion device and the luniting soil characteristics.
TANK CONDITION(5-10): 5
Tank inspection indicates:
OPumpout not needed at this time.
6 Tank must be pumped out this yeaz (city code requires tanks to be pumped out every 3 yeats. Tank was last pumped_ ).
7 Solids accumulalion in tanks is at a critical a crilical level. Tanks should tx pumped out as soon as possible.
8 System is discharging to the surface. Tanks must be pumped ovt within 48 hours to eliminate surface dischazge.
9 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia pipe)must be installed in each tank at next pumpout If tanks
have not been pumped out within the last three yeazs,they should bz pumped out now.
1� Inspeclion pipe is located directly over tank baffle(does not gica accurate mzasurement of solids accumulation). If tanks have not been pumped
out within the last three years,they should be pumped out now.
DRAINFIELD C�NDITION 11-14 : �
1 Drainfield is dry,no surfacing evident
12 Some evidence of surfacing,not crilical ye�
13 Drai�eld is saturated and visibly dischazging uirtreated ef�luecrt to the surface_ Contad the City Inspector immediately.Repaus must be
completed within 90 days.
14 Drainfield estent and condition unknown.
COMNIENTS: s S�-�M � S 0 (� - P� �IC ne
�eS� _ T�—� fio keeD ��-Mal o� r�d� �� w �te�
6��5-�\ ��C
Date of Inspeclion Septic System Inspector '
Note: In the event that this inspection report is used to satisfy the requiremeais for a mortgage or other transfer of property,be advised that this repoR does not guarantee
or certify that an existing system will cocrtinue to function properly,but is merely an opinion of the adequacy of the system under currerrt conditions based on the available
infoanatioa
r �
SEPTIC SYSTEM INFORMATION
S TREET ADDRE S S l / �� � �.'� �-: 'r.-' ''-.�°--�C�1_�?xl� �e�t f L,,,,.
LOT ,�, BLOCK / SUBDIVISION ���j/'�%7'�"�S (/V�r�t.,.. `:.,'
MONTH AND YEAR TESTING DONE�f�BS �
ITEMS ALREADY COMPLETED
2 S U( �.. �'�.��X' 'r�-t� ' l� %�J t�� t � r�� e:��",� F-!L E �
NEED TO COMPLETE BEFORE ISSUING BUILDING PERMIT:
�ORINGS
��C
�PERC TESTS
j��
SYSTEM DESIGN
SITE PLAN
O OTHER
(J() COMMENTS
�V'
���/ '�.-`, fi:.. .., -e C�, . , :' `!r..' ( -t .�.�k�i1,a ��'.�.�.,��,�I C ��t..� '��-E.�a...�
L � .
DATE THIS SHEET FILED �f� '� �- � �� BY G/�
SUBDIVISION FILE NO.��.��
. �
+,b6Z
!
� +,5 0�
r �. �I ` O
��, � o
'� I �
� � ISOoo^
,_ � �� � '� --- �
� � \ /
�r / /
� / /
� �
i / i
_?1. N ��� -__�_-._�," ,� o / �/ ���
; ..._--�.... � ; � o i ����
� � ` � � 1
i � a � �^� � � l� � � � � (
_ ,
,
1 T W� / I ` \
� - ;
_ o_ � si � � `�� �� �
� � ��°��G � � �o � �� �o
� - - ' -_ - _`_` �
3 `
_ � , Q�Ui J //; .\ 9S6
\ � b�
/ 6
.. ' , '__ �� : / - .
_ �
....., .. _.� I
/ � � f pe
( C Cz /� , __.____\ , � \ 0.
__�� � _ - � �,� � ��
.\ ` �
��._i'� ��� �" , , �����. . � � � �°
�� � ' � �
�� _ � �'',e e -� ,o � �� `, , �
, ;,F - � _._ . . �o � - -
v - � h \ �, .�,�'� � "
_.
� U.: �` � „'.'� qee . i 1`.. �oo.o°r \ � _.__.. _ . � �j �.
_ � :� � ' �1 .i `
�
. � . _ ___. .� � � � `�V,��c
1_
�/ � _ � . � '��. `` 'lOY
� _ . ' . i����A � - ._��� _.
o�' ��
Yl �� ��'_-�
Yl \ _ _
� � ' � . � � ` ` - ��. - �
'/� 1\ �
,os % \ ' � 5o i -- -_- _ _ _
� b � ,°+-�' ,�e h � � .
� a � � Q \� �
j �-?� Q.; �ae� -- --/,
� . , . N �1A N ``1 C . 1� _
��
�u V �O/ �'1
� a a 0 � �, .Qp r . � �y'�
N +�+�+� / \ y.
�r � �h tir h � �
y c�
� /`h ;" � - � �
; -_
`,�, _
__,�.0 ,_� � _ :� --- - - -
- � ' - -
' --- - --
� _.
� �'� \ ��.. /N10//�� _. .._ �'.... _._._ --_�\ �� �
� \ .. ' _ _—- _- _-_
'r ' m� _ -- „i � ' _._ _ � �— - -
� ► W � _ _ � ,
W � ~ ` /1� ,,6
� �' 3 ti 3 � ,o0
� � � ( ,A o..� i" �- �l� - " � .
,. .._ .._' / Q � — ; y, __.--- --- - -- �.
� ' _
�_ 1 ' , .. _'.97P�- ���� .
--�, � O `x .. _. �
��... \ . I �� / - _._� iy . -� 41 7/
.. � � ... . , _'
, �'. . % / :� i /�' _ � _ ' _ /
� - ��. � ; . - - __._ _ ` _
_ . / / , ._-__ _...._ / .. - .
� � � 9BL- - /" __
� � � __ _ / _ ' %
� � �� /� � ,,e° ''� �/� /��-� �_
� ___��,/ atp' _ — , � �
� � �� i W
- `� �e� _- J . � o�
t � � � i �' � '
, � q /
7 [ /
� ge3'- � d'�
. C . . � . � / q°�4' _ � ,OD
. �li I . � � /�' � / •
/� / // 9n6'.
�� _./ / i i" ��g' \
o v �' / / � 50 �
w /
ati � � ��� ' i / _
� �. � , % /� � ��-- ��-� ��
o /' � / ,` � ,y \\
i / a�r_- -- � `\� ,
? I I -A�/ �� /' \ \\\ \