HomeMy WebLinkAboutSeptic info 04/22/2016 11 :47AM FA)t 9528733112 f�0001/0004
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�� Minnesota Pollutian ��m1�-t tiance Ins ection Form
Control Agenty 1�' p
520 Lafayette Raad North Exlsting Subsurf�ce Sewage Treatn�er�t Sy�#ems (SSTS)
SL P2ul,MN 55155-4744 Doc Type:Campliance and Enfor��ment
Inspectl011 resuks based on Minnesota Pollution Control Agency(MpCA) For local tracking purposes:
requirements and a4tached forms—additlonai local requiraments may also apply.
Suhrnit completed form to l.ar,al llnit of Government(LUG)and sysiem owner NrIC L L LU 10
withln 15 days
CITV 0�ORON�
System Status
System status on date(mmlddlyyyy): 4/21/201fi
� Compliant—Cel"tificate of ComplianGe ❑ Noncompliant—Noticg of Noncampli�n�e
(Valid for 3 years from report dete, unless shorter time (5ee Upgr2ds Requirements on page 3.)
frame outlined in Loca!Oid]nance.J
Reason(s)fior noncompllance(check all applica6l�)
❑ Impact on Public Health(Comp/lance Gompenent#1J-Imminent threat fo public health and safery
[]Othei'ComplianCe Conditlo�s(Compliance Component�t,?)-/mminent threat to public haalth and saf�ty
❑7ank Integrity(Compliance Compa�ent#2)-Failing to protect groundwater
�Other Compliance Conditlons(Compliance Component#3)-Failing b protect groundwater
❑ SOiI S9pardElon(Compliance Cofl7ponenf#4)—Falqflg to prpfeCt groundWatEr
❑Operating permit/monitoring plan requirements(CompNance Component#5J—lVoncomplrent
Property Informatien Parcel ID#orSec/Twp/Ranqe:
Property address: 1820 Fox Street Orono,Mn 55391 Reason for inspection: N/A
Property owner. Lynne McDonou9h Dwner's phone: 612-839-4100
or —
Owner's rep�esentative; Representative phqr�e:
Local regulatory authority: _ Regulatory authority phone:
Briaf system desc�ipdon: —
Comments or recommendatians: —
Certifi�ation
I hereby eertify that a/!the necessery infnrmation l�as been gathered to determine the compliance status of this system_No
determination of future System performance has bean nor can be made due to unknown conditlon8 during system constrUction,
possib/e abuse of the system,inadequafv malntenance, or future water usage.
Inspector name: Josh Swedlund Certificatlon number: C1659
Business name: Swedlund Se_tlC ServiCe L.iCense number: 2502
Inspe�torsignature: _ Phanenumb�r; 952-87}3292
Necessary or Locally Required Attachments
�Sofl bonng logs � System/As-built drawing � Forms per lor,al ordinance
❑Other informetion(list):
www-pca.state.mn.us • 657-z9b-6300 • 8Q0-b57-3864 • 7TY 651-282•5332 or800-657-3864 • AvailabEe in alternative formats
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04/22/2016 11 :48AM FAX 9528733112 f�0002/0004
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Property address- 1820 Fox Street Orano,Mn 55391 Inspeotor initials/Date: JS � 4/21/2016
(mm/dd/yyyy)
1. Impact on Public Nealth—Compliance compone�t#'! of 5
Compfiance criteria: _ Verifi�atlon methad(s):
System discharges sewage to the ❑Yes � No �Searched for surtace outlet
c.�round surtace. ❑Searched for seeping in yard/backup in home
System discharges sewage ta draln �Yes � No ❑ Excessive ponding in soll system/D-boxes
tile or surhace waters.
0 Homeownef testlrttony(See Commenfs/ExplanaHen)
System causes sewage backup into ❑Yes �No ❑°Black sofl"abovQ soil dlspersal system
dweliing or establishment. �
[]System requlres"emergency"pumping
Any"yes"answer above indlcates the 0 Perform�d dye test
system is an Imminent fhreat to publ;c
health and safefy. ❑ Unabte to veriTy(seB commenrs�Explanation)
_ ❑Othef ine[hods not listed(Sae Comments/ExplanationJ
Commentsl�xpianation:
2. Tank inte rity—CQm liance component#2 of 5
Gompllance criterla: Verlflcation method(s):
System conslsts of a seepage pit, ❑Yes �No ❑ Probed tank(s)bottom
cesspool,drywell,or leaching pit. (� Examined construction recards
Seapage pits meeting�o8p.2550 may be
com l;ant if aUowcd in loca!ordlnance_ ❑ Examined Tank Integflty FOrrn(AtfAch)
Sewage tank(s)leak balow their �y� ❑�bserved liquid level below operating depfh
designed operating depth. �N� pty(pumped)tanks(s)
�]C Examined em
If yes,which sewaga tank(s)leaks� ' ❑ Probed autside tenk(s)fqr"black soil"
1411J/ `�)/eS"answer above indiCates the ❑ Unablg to Verify(Sae Comm@nts/Explanatron)
sysf�m is failing fo prot�ect groundwa#er. ❑ ather methods noi Iisted(3ee Commenra/�xpJanatlon)
Camments/ExpEanatlon:
3. Othef C0111plianGe Conditi0115—Compliance component#3 of 5
a. Mainfenance hole wvers are damaged,cr�eked,unSeCllred,or appear to be structurally unspund. O Yes" �No p Unknown
b. Other issues(elac�e�hazards,er�.)to Immediatefy and adversely Impact public health or safety, p ve9* 1�No ❑unknown
*S�rstem/s an imminenf th�at to public health and safety.
Explain:
c. System is non-proteCtive of ground water for other Conditions as determined by inspecfpr, p Yes^ �No
*System is faAfng to proteCt groundwater.
Explain:
www.pcastate.mn.us • 651-z9b-6300 • 800•657-3864 . TTY 651•282-5332 or 9Do-657-3864 • Available In alternative formais
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04/22/2016 11 :48AM FAX 9528733112 f�0003/0004
Property address: 1820 Fox 5treet Orono,Mn 55391 _ lnspector initials/pate: JS � 4/21/2016
(mm/dd/yyyy)
4. 5oil SeparaHon —CompEiance component#4 of 5
Date of installation: _ � Unknown VerffiCation method(s):
(m�rvdc�rrrr)
ShoralandlWellhead protection/Faod bevarage Soil obSelvallon doas not expire. PrgyfpUs soil
lodging� ❑Yes � No obServatipns by tWo independent pe�'ties are Su�Cleni,
unless site cond!llons have been eltered or loca/
Complianae crfteria: raqurrements diffar.
For systems buift pnor to Apn!9, 9996,and ❑Yes �{ Nq ❑ConduCted soil observation(s)(Attech boring logs)
not loc�ted in Shoreland or Wellhead
Protecfron Area or not s�rving a tood, ❑Two previous verifications(Arracn nonng logs)
beverage or lodging establlshment; ❑ Not appliCable(Holding tank(s),no tlreinfield)
Drainfield has al least a tWo-foot vertical ❑ Unable to verify(Seo CommentslExplanatJan)
separation distance from periodically ❑ �{heI'(5se Comments/Explanatfon)
saturated soil or hedrock.
Non-performanCe systems bulR Apri!9, �Yes ❑ No Cammentsl�xplanation:
9996,or later or fi�r non-performance
systems located in Shorefend or WeUhead Soring.
Protection Areas or serving a food, 1-12"10YR 2/2 LoBm
beversge,or lodgfng estab�ishment:
Drainfield has a thre�foot vertical �3-29"10YR 4/4 Clay Loam
separation distance from periodically Motts�29"
saturated soil or bedrock.*
"Experimenfa!" "Other'; or "Performancw" ❑Yes 0 No IndlCate depths or elevations
systoms builf under pre-200$Rules; Type!V , - �
or V systems built under 2008 Rufps(7080. A. 8ottorn of distributlon med;a +�2"
2350 or 708Q.2400 {Advanced Inspector � - - —
L1Cen5e requlfed) e_ Periodlcally ssturated soiUbetlrock 28"
Dralnf,eld ms�ts the designed vertical C, Systam separation 4�"
separation distance from periodlcally -
ssturated soil or bedrock.
_D. R9quired CompllanCe seperation' 38"
Any "no"answer above indicates the sysf�em is 'May be reduced up to 15 percent if aflowed by Local
failing to protect groundwater �rdinance.
5. Operating Permit and Nitrogen BMP"—Compliance component#5 of 5 � Not applicable
Is the system operated under an Operating Perrnit? ❑Yes ❑ No If"yes",A below is requlred
Is the systam required to employ a Nitrog�n 8MP7 ❑Yes 0 No If"yes",B below is requlred
BMP=�est Managoment Practico(s)speclfied fn rhe system des�gn
!f the answ�r fo bofh questions/s "no", this s�ction does not need M be Completed.
Cornpliance criteria
a. Opereting Permit number:
Have the Operating Permft requirements been met7 �Y� ❑ No
b. Is the required nitrogen BMP in pfgce and properly functipning? ❑Yes ❑ No
Any"no"answer Indicates Noncompllance.
Upgrade Requirements(Minn,Stat.§115.55)An Imminant threat to public health antlsafety(1TPMS)must be upgraded,replAced,or its use
dlscontinued within ten months of recolpt of this notice or w;thin a shoner perrod if roquired 4y loca!ordinance.!f the syslem ia faiUng to pratect
ground water,the sysfom must be upgradad,rep/aced,or ets use dlscontinued withln 8�s time requlred by/oca!orclinanee.lJan existing system
Is not fail;ng as doflned in law, and has at least hvo feet of deslgn sor!separatlon,tiren the system naed not be upgraded, repaired,replaced,or
rts use dlscon�inued, notwkhstandinq any local ominance that is more strkt 7Hrs provislon does not appy to systems rn shanland areas,
lNellhead Protecilan Areas,oi those used in connaclion with food,beverage,and lodging esta66shments as deflneC rn lew.
www-pca.state.mn.us • 651-296-63op • 8Q0-657-3864 • TlY 651•z82-5332 or BQO-657-3864 . Available in akCernative formatr
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04/22/2016 11 : 48AM FAY, 9528733112 �0004/0004
Swedrund Septic Se�vices, I�c.
25b48—2Q0'�Street• Belle Plar�e,MN 56011
�..yhn e /�G,�o�d�� yS2-873-3292
� g�� F�� �� Josh .T. Swed�urtd Lic.#2soz
w r,,,��/Z�-�� /l�/(/ SS 3�`� __ Date: �/ �����
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07/13/2010 02:07 7634975011 SPTESTINGINC PA6E 02/09 V
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, �-P' T�'S`T/NG� �N ,�. Steven B. Schirmers • MP
951 Katydid Lane NE• S� Michael, MN 55376 (7 3) 49703567
6
FAX (763)497-5011
State License#394
July 7, 2010
McMiilan Residence
1820 fox Street
Orono, MN
A Cvmpl�ance Inspectpon was comp�eted far the existing on-site sewage treatment
system located on �is property. The system consists of 1-1000 gatlon septic tank, 1-
1250 gaUQn septi�t�nk, 1-1000 galfon purt�ping chambe� �a pr�ssurized mound
system with a 10'x 65' rock bed for a 4 bedroom home & 1 bedroom guest house. Soil
boring#1 found mottied (redox features) at 2.5' below the ground surface. Soi�bori
#3 found the original soil at elev.97.3 &the bottom of tF�e rock bed at elev.97.9 leaving
.6' of sand below the rock bed 8� a 3.1' separation fram the bottom of the rock bed 8�
redox features. Soil boring#2 found mottleci soil at 4.8' below the ground surtace. Sqil
boring#4 found the original soil at elev.95.8 $the bottom ofthe rock bed at elev.97.g
leaving 1_2'of sand betow the rock bed �a 6'separat;on firam the bottom of the rock
bed $ redox feafures. This system is classfied as in compliance with Minnesota
Chapter 708D rules.
The tanks were pumped by Sullivans Utility Service&were found ta be compliant at
this time.
Nothing other than gray water(iaundry, shower�, etc.) human waste 8�to�let tissue
shouid be disposed of into the septic tanks, Garbage disposals are not recornmended,
due to adding more sofids &fine sotids passing through to the syste�n. Ftecomrr�;nd to
divert iron fitters out�f the system, recornrr�nd to divert the watec sof�ner also if
diverting the iran filter. Excess;ye amounts of soaps, antibacterial soaps, cfeaning
agents, shower cleaners used every shower& chlorine agents may kill the bacteria
needed to treat septic effluent Additives are not recommencled. Recommend to pump
� ctean your tanks fhrough the manhofe by a certified pumper every 2 years_ Check
with yvur pumper to set up a schedule.
This Certifi�ate of Compiiance is no guarantee that this system will continue to function
indefinitely.
`f`-�� �_
S even B. Schirmers
bli13/1b1� 02:07 7634975011 SPTESTINGINC PAGE 03/09
- M",."�5p�, P�"u���" � Compliance Ins ecfi�o
� ControJ Agency p n For
520i�faycKeRaadNorti� �xis#ing Subsur.face Sewa g e T r e a t men t � $fems m
St.Paul.MN SS1S5-Rt9a Y . . ($S'y-S�
n��T✓Po=Compl/aYice end En/or�empRt
� lnskructions on page 7
Summary Farrn (comp�eted fo�m �
must be submitted ta the Ipcal unit of government within 15 day�.)
Per�c�1 numbor.
-_ —_-��.—�--�_
SYs►Pm status: �Complianl ❑Noncomplian( --
------
For local Tr�Cking Purpose�—` —
(bAse�I or�alt cpmp172nCe�quiremenfs) ~�i
. I
Property information —� � �
Properly�wner name(s); t�`~-'—�I
.�1�1"1\�.,��1� ` A►ap�
ProPerty BddrRCs: �J--=�."'� -�!���G.— Property owner phono: 9SZ-�►?aI'- q'ZO,�
ProPerly owner address pr dlfleren��: ����r���t--�.��`1 C7 — .
County;�{�j��Q�,� . ---�-- • ---,—
���A syslem Constructpd: Permllting Bulhbri�y; ;4�� • �_„�
�.�QO� �'�4��__ .
�___ Reaspn for Inspection;�Q -��.-�_
5yste� Description ����5��� .�_�
I� 1 2S'oOya�S'a.�:c-Cca,�J�
B�Pf SySIBm�egcri HOn; ,..• • � '
n � �000�a„j��l.�� �_tvd�
. t_ocai permil numbec -r�—°��- �?�+?G
�' Nurnher of beclroa�9: ���*M-��'�-'��-� �G
IS khe syst�m: •�� —5_ Design flow raEe: �����"
� `� 1 u��eyT t���a �A4-A���
1�Shoretand:��ay . � -
d Yes � Np In WeIlheAd Proleclion A�ea7
An U,g, Envlronmen�y�Protection ❑Yes �No
�gency(EPq)Ciass V�njoctlon wep� 5ystam serving a Mlnnesota pepartrnent
- ❑Yos •� No 'of Healh(MDH)Ifcensed f�clliry7 '
C�rnplianCe St�tuS (eased on s�a - . Q YOS f�No
Based on the inFarmafinn gathere�i and rePa'rted on altacl ed Formsr lhe compllancerst tus�f thls s'y) .
� Certfflcate of Cornpliance-valid until(3 yeArs from dale of report): ystem is(check one): .
❑ Nolice of Noncompltance-For Nr�ncompliant systems: ^
The reason for noncompliance fs; '
This noncompliant system Is classlfied�(checic ono below��
d Imminent threat to puhllC haalth$Sefety �]Fa;ling to proteCl groi�rld wale� ❑No�;n compliance w(tll oporsBn
Certific�tion 9 Permll
!he�eby r•ertify(hat a/I fh�nacessary'/nforma�ion has been g�fhored to detarmrne!he compliance s►a(�rs of ll�fs sysfem,No
delo�minallon oI hnure system pertormance l�as bAen nor esn f�e mado due to un/cn�wn conAitions durin
possihle ahtrse of fhe Sys�am,inanequate mainfenance, or fu�ure water usage, s stem
NamQ�
9 ,Y ct�rlslruclion,
—`'�-�.��. Sc.N-���s—
Busingss llCengg narne an(1 number ��� .,� --T-- CartlfiCatlqn number. (Q ���
Name oF lo��unit of g�ve enL ��-��' '��C L� �' ~—���"'�
/=—V. �- � �-t7�-�_�'s3�bl�,or
5ign�ture; �' ----_�._
�-�—�-- Date: `��(y201 O • .-
Required Attachmehts . —�--�_
� Hydraulic Performance
� Soll Borinc�Lvgs �Tank Integrity , •
� Soll Separallon � OPe►'ating permlt Form (if appticable)
�Syslern drawing/As-huilt draw{ng [] Any local requirements lhat aro difFerent from what is required on
❑ Other Infnrmaf.�on(ilst): • th[S form
Upgrade RoquirQments (de�lved from Mfnn. Staf. 'l15,55)�— �
�Pplece.d,or fts use d�sc�,��u,�ed wnhin� § �n Imm(nent fhrgst fq p�p)��17ePlth anrl� ��
ialfinglo profod gmtmd wgfe�the r.ysfem musl�Ge u`rb�!of thrs nof/�1g or Wrthln e eho�Ter porlo�//fre u�d be�b�TPNS m�.�st pB �`
ex�sU�p$ystem Is nql fau 9 y ce/o�AiRante,/J�h���ed,
/� d'BPl�ed,or qs vy@ Ul�nlfnu9d wlfhin lha.[Ime requ/rEd b �� SYslem k �
�A�d2//nad in lew,end 1�es et leec�rwa foe�o/des/ n splf se
rr�plecep.or fts use d►scpnflnugd,nOfwHhS[9rtding ony local ord{nence thal is tn8 �aflon,fhen ti�SySfem neep n��i pqrade�d,•rQ�,1•o�,
eraaS,Wppry��p��ectlon,MeaS.or those used in con aa slr(eL Thls ro
necflo,i wlfh/opd,bgveraga,end!a p "lslon does not epplY�o sysfoms!n shorefand
``�~--- �8'�9 astaDAshme,Ms es deCnTed In law.
`xv�c.pca.state.mn.us � b51-�96•6300 . '
Wq•�wvtsts•1-31 • ai tora9 �-6 5 7-3 864 • T(Y 651-282•5332 0�Bpp•657-3864 � • � -�- .
. Available in alternabve formats
.._.. . ._ _
07/13/2010 02:07 7634975611 SPTESTINGINC PA�E 04/09
� -�
_ Percel nilmher: �
. ._ --
, �^� �� --- � -.---•-.-,._. SYstem 9tatus: ' �CompllAnl ❑NoncomG���nl
(as delermingd hy/li/5 IormJ •
Soif SeparatTon Corr�
pliance and Ot�er Compliance- Comp/iance lrlspection Form for
Comp(iance lssue #3 af 4
Data ofohserva���n: �Xlsting SSTS
THis info�maflon on Ihls h�rrn�` ���� -- �eason fpr nhserva6on_�
daes nol expire_
ComplianCe ' �������� --
�ues(��ons/criterie: (t��uired) ���
_ Ghock lho�p,n ���e�ox�L
ror systCms bu11t priar tq/.� �� ue�ificat'lon Method`�;(pPponal)
~�� -"� (Check the a
locate�l in Shorelsncl or We Ihead�P os�hnot I Ppropriate 4oxJ .
'4�ea o�nnt serving s food,beverage�r I
� Conciucted soit obgarvatio�(5�(��ach bori�q��5�
1oc19�ng est2blfshment:
Does.lhe S $ ❑ Two prpvlous veriflcallons �
Y tem have a(Ieast a two-foot ��«ach noring Ir�q;�
vertiCa�separg�ion dfstence fjb 0 �=her; �����
_�ahrr?ted s„oil or bedrock? m periodicallY . �„�g���
Far no�_ � -�..— L]Yes q No -��-�-�'-���L��^(�---�
Perfnrmanr,e syc�ems buil!April t,
1996,or leter o�fnr nq�.pe�rtttance sy�temg , ���-�lr�A�1�`$_�L1
lOC'at�'4 ht Shorerand or Wellheah I'rot�Ction �����
Areas or Servin ' . . ��"�_ .
estabi�9hmont: 9 a food,heverac�e or fodgfng ' SO1��dseNaUon does not explre, prg��o � ~��-
• by two indeK,endent art(es �' °b�wations
Does the sys(em hava a thre f � • condltions have►aeOP a��eredre eutll���������oBS
seRaraCon dlstance f�n �°Ot�°n�cat 91��
S-_°i�J o�bedrock7' m�eriodfcaily S�lurated � , .
� �er r�d�Ced sepatac a,1 dislanc�systsms•(I.e„ Yes Sj ry_� •
ance'systems uncler o!d 7080.0179��-
Type fV ar V system under new 7080. 7350 or
70$p.24Qp); ' May he reducod hy un fo 15 percenf if altowed
�oes tho s ord/nanr,E. /n loCa/
yslern m�,t t�e desig�ed vertical �'No s�andard
sepa�tion distance from�eriodfCall in svquent/al prtJe��D doesttrindlSr is
Sot�or ix�d�o�kti• y saturated �o!axhauylrve,
Any«ha.. — a+mb/nalions arQ noce$sa ��e whlch�
e�swer fndicates tha[t Y�� N� Uelermind/ip�, �'ro make thic
9ro�nd wafer. ���yster►�Is fsI/ing lo protect
Certificatian � � �
Thls form Is to be completed and atfached 2o the Summa
IttspeCtinn FoRn for�xlsting Su�isurfa�o Sewage Treatmen �f tllo Minnosota P
COmp�e��by an.in�per,tor or dogigner,C�m o11i'�On Lontrol Agen S -
pleted forr��ust he subm�itlod o tlSe I c I unl!o�f m�tatlons,a d tconclu5ion.c�m�t bP
1'!'operty owner name(�): govemment with�n �5�2Ys.
Prapert a �a-�"�4� ��' . .
Y ddress: . 1�� — �y__
Property owner's addrEss(1Ldltte�O K� � / .
D._�p
Counry: ~ . �� --,--.— `��
. ' �`
"-------.�_ Properly ownar phone; -','.�`�,—�� �,,�.
1 hereby cP��y lhal/pQrsona!!y mado th@ QbseryPlions, � ���`�Z`��=���
corr�ct, terprelafians, a �
nd Concfusions re � -~`
• PO�(ad on fh)s forrii and thar lhey a�
Vame_. 5.���,�_ , „ �� -
,�L�4�.�,
3usiness IfcPnse n2me and number. �``L� Cenis�tl�n number.
�ame 5..�'..����l�a � --��
�t lpcal un�ovemment: �--��-�--�-. . ---
>Ign2lur�: / ��7.�.�.�=���7 -
�Y i.��r .. ---��(r�---`_ or
'--�,..__..
. . �--� Date: �_-'(o-'?�LQ_ —�
� ---�
n�c�r.pca.state.mn.us�• 651•�96�r7g0 • $00-657•3gbq • TT1r 651•283-533Z o�.80a657-3864 • qvailabie In alternative fotmats
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�7/13/2010 02:07 7634975011 SPTESTINGINC PAGE 05/09
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_I'arrol number: � .
_ ' � •-•--• -- -• -- • ---•--- ._.__ SYstem stalus; �C��npliqnl f]Nonco,�pilant '
(as de(ermined hy rhts inrrn)
Hydraulic Pertormance and Other Gompliance - Compliance /ns ect'
�ompliance lssc�e #1 of � p ron Form for Exisfing SSTS
Dale of observ�lion;
—�=�=ap�� Reason for observ�tiort:
7hls form explres upon next Inspection or In three earg, ���-�-���`�
Y whichever pccurs firsL• ' �—�—
Comptiance -------� `�
questlons/criterla; (Requ;red} � —"`
___(Ch�cl�fhs anp��fato boX��_� Veriflcatfon MePhod': (OpHona()��_�^.
D�es lhe system discha e so_ � --' (Ched�the a
.�rp��nd surface? � `"'a9e fo the � ❑Ye^. �,N� Ppn�prlete�x�
Does the syslem�fischerge sewage Io drain � � S�arChed f��surfacp oullel
—����_`�
«�e-��r sur(ace water s? �Yes ❑No ❑ Ferformad h y d r a u U c t e 9 l
Doeg the systerlt rause sewag.e vaCku�PS-� � � Sear�od f��9�pi�q�n ya�c1►.Ip
int—°�o��t.ng or establis��mQ��q���� � No� ❑ CheckPCl for bar..lcup It�hc�mo
f�o olfier sltuatlons exlgt Ihat lteve Iha � � Excasslve ponding in soil systnm/b-boxas�•t0
potenllal Co immediately a���g�,��e1Y ❑Yes � N�
impacl or q����en publlc hea(th or safeEy � �. HOm''�wnar lasiimony
_�electrice�,t,nsa�fP covers,etc, �
- f_7 Examined for�eury;n9 in lank
Any�•yeS��a�31Yer/nd/cates(hat tl�e system is an/mmin�- 1�
t/ireat fo p�b�����Qa�th aryd hA "Black soi1'ohove soil
�. sa�etY� dl9pt3rsal systerrl�y,0
—�-` [] Syvtam requirns"eme enr. -
Dcyes the system pose a thre2t to�—� ""' � .y pum�ing
water for any condipons deem�^o�und Q Yes �,No � �'erTormed•dyo test
�prntective as tl�te�m��ed h�e�Rg eCtor? { ❑ �ther. ��
..1'�5"!ndlCates[haf�Q System 1�(�j/�n to �
grot.rnd water If"yes", descrihe fhe Co�,tt���ed: ~-
__ _-- . --'_--�'"_,—
__ ' — ___ � "No s�and�rd protoco!oxlsts. This Jist!s nor exhaustive,
• —_. _�_ " . In soquQntra/orrJer�or does ll!ndlCate wl�ich �
—�•��_ comb�natl�nc aro neGessary ln malie thls delcrm/nafion.
Ceftl�lCdtlOn � '
Thls form Is to be completed and Ptt�chacl to the Summary Form oF the Mfnnesota p����; •
InspecUon F�m�for Existing Subsurtace Sewage Treatment S tems.
Complp���y An insppClor,Com letod form miist be suhmihed'to Ihe loCal unit oF ov� ton Cont�p��9p���g(MPCA)Co��p�lance
p Ys Ohserv2tions,inlorpretatlons, and concl�,slp�S�,Ust he
Frp en � 9 rnrnent withtn 15 deys,
P .Y own�r name(s): �d�`���
Properly addrQss: ���b FQ� ��-��,/ �' —�_.�.
PrD eR �`-�'r�'"�---�--�0_ •.�L(7 ~^ "�."--•�-,
� y owner's edcJ�ess p(dltiernnt): — - �-
COunly: ,�� —"—� . ---,�__—
��"—�• ._ hro�ortypwng�— Ph` ane. AUb• --� _
f hereb .�_q�2;,�-��'Z.D7 �
y cer(ify Ihaf I pPrscma�� mano�he�bseNallons,/nte refal/ons, and conc-Jusi�ns�
corrocc. y �p . —.-�._
Pculed nn this forrn and lhat they are
Neme: ���Lr'G�.��Ij��Li� .
susiness license name and.number: �``- ' Cerflf►cation n�mber. _(���__
�•P'��r.�1�1���� �
Name or iocat u_r��t of9ovemment: � -`�a'�"'�-�1-r-� ���,�-�g —"`
Signature: ��.-�_ y . • • `2�'�`�- _ or
� --,---�
. � ---_ Qate: '�< <��� ---
. . �_
wwhr.pca.state_�ci.vs� �• b5t•296-5300 • � 84p-�651��$�� .
wq•wwlstsa-3r • 4!TOlQ9 , � 1�Y 65i•28z�533�nr 800•657-386�1 • Available in altemative formars
� '� '
. , Foge 2 o f 8
07/13/2010 52:07 7634975011 SPTESTINGINC PAGE 06/09
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Jul 12 10 90:25a TIM - ���-�2 �ooliooi
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11t1s�ne expireb nn(�ree yeMs� -
coR,pn�oer au.sbveslr,lmtir:�eq�d� Ifar9Raaan metho�f'":�ionan
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Oo�s!he qetem co►�t ef�oaepag�p�'. 01(es (j�l�to Q Pholfa�4 wnk bekas -
OP
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� � E�ned oo�t tic�ori�a�ds
. �fl���Y���9e �6oeetYled empl!'(D►�nDe!!1 tank
. � t�t11t IeDlcs. ❑ P�abed oiAekb�nnlc 1�"�I�dt eaiP �
�1��ArAesMs�t ibe�a�n Aa�9�oProle+et [a Pias�iNeMewn n�eck
����i�tFS.�u�conq�e�i7 aRowee
❑ L111fer, �.�..._..�._.
"'11l�sund�ndorvba'a!MRbts lAts!lt��ncRa�aAar�fJN►f�
6l4usn�irl mdhr.nar at0061!4i0oefa��
' O1�I!�lmtry'Ib,�,�l�E1A f�llr►M4Yf�of�.
Safi�tyr Ch+�Ck
1. laje em msA,►en■�rcs bow sw�fe derrtay�d�asd�d.a ap�e�cedt4ee atna�n�unoovnd4 ❑Yes• ��,�p
4. WeeQ ott m«�hole e�ea�laeed!n�sedl�ed na�nns(s.4.RI�aonon�e t�Nodd17 �Yat Q Nle•
3. 1Nae eeca+Obry Aooe9s fassdM p�K(ew�y P�rt,s�aond c�r�ar eefl�h nelilr�p,NpMy�.Catim�d. Q Yos �Na
4. Was any a7��/lwa�f tert�e p�ant? (J Vi�s" �n10
�
�S�rn is ew Jnwri�wo�f fiwMerF fap�8i'rc be�1MG�oFaa�i�i�
Cettiflt�E14�
Thls fenn�tn de o�x+�Meled and ae�bed bv the 8un+�e�erfr F�m afthe Nlnnosor Pdh,t�on Cbnaa!Ao�►'�Q�PCA1 Ca�npN�nee
t�p��'�aw TsF'�97Ag��e�w�Me��pie�+�e.aBeewepo��,ia�erp�ta6am.wnd�ctus�ns nn+e�i�
� ;�W�x+&�caa rtfah►tainar.ar sea�roa v�ouidor.Campretad 1�nn n�ec b.sub�nm�d��ehe baot untt or geyue►nmem wu0+m
ptal�er�awn��): ��,i►ce:.✓► _ ��,,;�t��o r► "l
p�oPe�dddnee�t r�2[3 ��C ��-�a�� �'?r � g �,�� S'��:.�L,
Pr��owner�ued�e.e!�erkre�q�
OaR+fy. �np o�-.� Rhone: 452-4�3- �ibo
�..-�..r.._......�
�+�sr.�bf►ot+rwY that f pweonaqy rtrede�e a0se�i►on�,gt�fpn�eiM op�npbele�s I1�pp�!a►d�te ft�n�nd fhar[Aer erg
eQereet.
t�me: "�.,.,.. ��.�,]yl�,� Oert�►ot�rtun+4er: _L__4_��_�i
9�tli�sa NGeft6e nafnl.► ber: ��,1!ti��,.v� c C)�:t!�� -.-.� � �� - ' or
tren�o�lae�l�rdta! CS t�rinA
�1°� oace� ,{a„1 7^ _�1 C�
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67/13/2016 82:07 7634975011 SPTESTINGINC PAGE 07/69
����
S-P TES T/NG� J,N�_ Steven B. ' .
Schirmers MPCA Cert.No. 627
951 Katydid L�rte NE • St Michael, MN 5537B • (763)497-3566
FAX • (7fi3) 497-5011
S'tate License#394
1.�2GS O�S_O_�BQgI.�Gg
McMillan Residence
1820 Fox Street
Orono, Henn. Ca., MN
Borings compieted on 7-1-10, with a hand bucket auger_
��R�-G NUMg�R 1- El�v.l Q1_6 - MOTTLED SOIL AT 68"- no standing water preserrt i� boring_
0 - 3$" Fill saif loam �clay Ioam
3B'� , 44" Original soil dark brown ivam 10YR 3/3
�" � 50" Dark gray brown Ioam 'I OYR 4/1
50" - 68" Brvwn ctay loam 10YR 5/3
Cs" - 78" Brown clay loam 10YR 5/3 -distinct mpttles 10YR 7h, 10YR 6/8
B6R�NG N[UMBER 2- Elev.98.1. - M4TTLE0 SOI�AT 66"-no standing water present in the
boring.
Q - $" Fill soil loam
g" - �8" Origina! soil dark brown laam 10YR 3/3
�8�� ' Z8" Gray brown ioam 10YR 5/2
28" - 34" Brown ctay loam 10YR 513 �
34" - 66" Yellowish brown clay loam 10YR 5/6
66" - 72" Yellowish brown clay loam 10YR 5/6 -
distinct mottles 10YR 7/1, 10YR 6/8
07/13/2010 02:07 7634975011 SPTESTINGINC PAGE 08/09
, -�
Soil borings cont'd.
B�R,�G N_ UM8E�2 3- Elev.100.8-through the maund.
0 - 92" Fiil soil loam
T2" - 42" Fill soil medium sand
42" - 48" Fill soi{ brown ctay loam
48" - 60" O�iginal soil dark brown loam 10YR 313
ROF�I�C �lUl��4.Elev.99_8 -through the mound.
0 - �2" Fill soii laam
12" - 38" Fifl soil medium sand
38" - 44" Original soil daric brown loam 10YR 3/3
2
B7/13/2016 02:07 7634975011 SPTESTINGINC PAGE 09/89
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07I@e/201@ 01;08 76349�5011 SPTES'FINGING rr-w� n.�i+�i
� �1'f�1 . 1'�~N,���
�arcel nurnbPx: , system statas: �Com�liet�t ❑Noncampdant
/A¢[l�rtA�mif►�r4 Mr fbka N um I
T�nk Integr9�yr ahd 5ltf�y Gotnplisnc.� -
/�wrM►a���a,t�es I��.a.� iF7 nC A "
�......r.�M��.... .��..� �.� .,. -. � -
Date crFobs�rvaCro� �--17 - C>i � Reason fo�observa!'wn: �'rc11 �s��:..�-2 sc�t�-
This tarm expires an(threa pears): _
Colt'�pliance qu8stioeslcHierFa:(Fteqs�red� Ver$ldation Methoul"'": (dptlon�}
�Check the avAropriate box (C�eck tho appmprr ate bax)
Does the system r.�rtsist af a seepage pit`. 0 Yes �No � Probec�tank bat�om �
cesspoal,drvweU,or leachin�p"rt?
❑ 4hsetved!ow tfc;uld ievel
ao any sewage tan[c(s)leak befow their �Yes No
tieslgned o��de h7 ❑ Ezam�ned can�'uctia�recards
Ii yes,idenMy which sewage � 6caminee!empt��(pumperi�tank
tank Eeaks. ❑ Prflbed outs�r�+aRit far"black sar�"
Aay"�s"answerindfcates thet the syste►r�Fs faFfing to pratect
gmuedxrater, ❑ Pressurelvacuuin check
[] Qther:
` seepaga piis meenng iuo`u.��u may p�compirani ii ai�vweo ---__..._.---
in ord'+nanoe by bcaf permitting euftiwity.
"JVo stertdatd pmfocoJ exists.7'hJs list is reat exhausfrve,in
aeouerttie!order, rror does h fnCfloafe whfch caunbinatk,n,c
• atE necasssry fo ma�;e Fhls tiet�+rm/Retian.
Safe�ty Check
t. Are arty main#anance hole twers demaged,crac3aed,er eppesred ta be strueturally u�so�md7 ❑Yes' '�No
2. wem a1t mairtt�r�anee hole eovets realac�4 In a secut�d manner(a�7..ait aaews teplac�d)7 �Yes i_1 No�
3. was secondary access restreint present(a�afetp Pan,secorxt caver,or eefety netyng>-f�ghly�ec ornmarscsd. �Yes �Na
4. Was any ott+er QafetyR►eaUh tssue pregentT �]Yss" �No
rxpiaa�:
'3ysiem is an imminsni aersat io�uniic nsaim anv saie"ry.
Certificatio�
Ttfis form ts to be carnpleteQ and 2�tached to ths Surnmary��r�n afihe NUrsnesota Poflutian Can:no!Agency's�tPGA}Comp#tanee
�----��__�_r.--�-�--•__...-�-••1---
retaErewuv��rv�w�wr caunurn3 aaayefUrRfct o��tiis��yC i icaviieii`v��i800�ny,Vo3oiV3pp(76,jfRE{'j)��LdppnS�&i'IU CO[1CIU31DRS fI1U9[OQ
compl�tetl by an inspe��r, maintainer,or secvice ptavider,Corttpteted irnm must be subrrtStted ti�tE�e locai untt oi goueritmetsi wdhin
15 days,
Propertyownerc�ame(s): ��>✓t�c..✓� �,���rl.�,�" i'F
Property address: �S Zo �c� SF-s�e c� !^,c-v rti.o i�c.J �'S"'�i`� 1
Properip ownef s gddreas(a dlfRerenty: „_ - , .... . �
County. ,�G�vLe i+� Phone: �SZ-L!7 3- 3�L L9�
�har�,by certily�&t 1 persanelly made ftie a6servatlons, fraFerpt�tations,and cancfuslons report�!on this hwm ar�d fhat they are
conect.
.,—�
idame: L i�,^'� �,ii,l �,l�G-n CertkflcatrOn rh�mDer: E���� �v `
Business tice�39 name an u�ber, t,:., ��s�s.-.�v� � C?, _)r • �/'. � � �� � or
Name vr loca!uNt at r ment: (� �,�,r�o
S�gneture: .,. oete: 6--! �7-, Zc�1:i7
� �
wq-wwlstt4-31 _ Ca»pfianCu lnspection Form for Exlsting SStS
41tl08 .
__ . ,
� � /
� �
' CI�'Y of O1�01\T�
� �
� � � ' MunicipalOffices
Street Address: Mailing Address:
���9 �'�G 2750 Kelley Parkway P.O. Boz 66
�E�7rI�
- Orono, MN 55356 Crystal Bay, MN 55323-0066
To: The Cun�ent Owner of Address � �v7 O �O��
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 followin` 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 broucht into compliance
within 90 days. Failure to do so will result in referral to the City Attorney for
legal action.
Systea3 Identified as Non-�ompliant
Yes �No
If yes, system must be brou�ht into compliance by:
December 31, 2007
December 31, 2010
ather
Septic 'Tank(s) Pump out Needed
�'es �
l�To
The City recominends the septic tank(s) and/or lift tanl: be serviced ancl pumped
c��.lt �v�_rv three years. City records indicate the tanl:(s) were last pumped out on
� _ f � �- D J . The tanl:(s) should be cleaned through the manhole and
not tlu•ough the inspection pipes, this allows for proper cleaning.
Comments:
����.E°�.�C,
Inspector: Date of Inspection ��G �
T1'e�e��on� (���1 2=r�-�6�D�1 � ��a ('9�?j ?��-����
3^��1�35'.C=.�rCS'3�.7's?�:.a.dS
///�——_ \\
' �\
i� � �
��
/;' ��'
%/ �
�'j� O � O \�\.; .
�' , �; !'. C ITY of 4RON0
���`, +� ,a r�•� �,��
,
� ,`�� ,! �" ,��� �.� ,�,�'�,� Municipal Offices
�, �, ,
� � " � `'�'' �� ;� Street Address: �I Sa-a4 q-y 6o O Mailing Address:
9xE$H�g�" 2150 Kelley Parkway P.O. Box 66
_
� --—"� Orono, MN 55356 Crystal Bay, MN 55323-0066
To Current Owner: Address: � o��� )�'c X �-}�
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.
YSTEM CONFORMITY 1-3 : �
1 "CODE SYSTEM"An ISTS which meets all the location,design and construction standards of the current Orono Municipal Code.
2 "COMPLIANT SYSTEM" An ISTS which does no[meet all the location,design and construction standards of the current Orouo
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 imminetit threat to public health or safety.
3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-yeaz flood plain,any ISTS which may
or may not meet a11 the location,design,or construction stanchrds of the current Orono Municipal Code and which is failing for any
reason;and any ISTS with less than ihree feet of unsaturated soil or sand between the distribution device and the luniting soil characteristics.
TANK CONDITION(5-7): �
Tank inspection indicates:
� 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 �'t5-�;`-� �.
Make sure septic tanks are pumped throu�h manhole and not throuQh white inspection pipes This allows for the nroper
clean�n�. Keep water softner and iron filter dischar�e out of septic system to prolong tife of draintield Ask pumper to test
alarm float to ver�f alarm�s st�ll wortcm in our house. The alarm warns owner that se ta e is about to backu 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(8-101: �
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:—_ Mu��� �- S�c�"� �c,n�CS �ccl� ��
�--Z-�-�U`�'l `�.,�- /��
Date of Inspection Matt Bolterman- Septic System Inspector
Note: In ffie event that this inspection report is used to satisfy the requirements for a mortgage or other�ansfer of property,be advised that diis 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 infonnation.
� o� _
o.:, o
�=��:��.�? ,, CITY of �RONO
�
� "�1�` .� '� �=�
;�' �•���"'f� •y�' MunIcipal Offices
� �� �#I�g G Matling Address;
� ��,�,�;; �'y Street Address:
� - E$I'j 2150 Kelley Parkway P.O. Bax 66
Orono, MN 55356 Crystal Bay, MN 55323•0066
. 95d-�4q-yboo
To Current Owner: Address: ���� �X s�'�.
City Ordinance 199 requires that each existin�on-site sewa�e 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.
SYS"I'EM CONFORMITY 1-3 : �
�"CODE SYSTEM"An ISTS which mcets a11 the locadon,daign and construction standards of the current Orono Municipal Code.
2 "COMPLIANT SYSTEM" An ISTS which does not meet all the location,design and construction standazds of the current Orono Municipal
Code but does meet the three foot separation rcquirement or two foot requ'u�ement for rystems installed 1996 or eazlier,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 daignated 100-ycar flood plain,any ISTS which may
or may not meet all the location,des o�n,or conswction standards of tJu current Orono Municipal Code and which is failing for any reason;and
any ISTS with less than three fect of unsaturated soil or sand between the distribution device and the limidng soil eharacteristiu.
TANK CONDITION(�:7�: s
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 tanl:s are numned throu�h manhote and not through��•hite inspection pipes.
This allo�1s for the proner cleaninQ.
7 Inspection risers missin�tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank.
INFIELD CONDITION -�Q : ,.,�_
Dninfield is dry,no surfacing evident.
9 Some evidence of surfacin�,not critical yet. �
10 Drainfield'u saturated and visibly dischazging untreated effluent to the surface. Contact the City Inspector �
immediately.Repairs must be completed within 90 days.
Co�rLI�NTs: �'`D`'^� "`�J ��^�S 1 o a k o�_ ��•• Se f,t ?�v�, S
n��c�-- Sv<.�..�� , Cv�.-r�..vt ,-D �e-�- �<`i15 �S�l�5��� o� ma J� .
� -6-0�. �a�c
Date of Inspection Matt Bolterman— Septic System Inspector
Note: in the event that this inspcction report is uscd W satisfy the rcquirements for a mo�age orother transfaofproperty.be advised that this report does not guarantec
orcertify that an existing rystem will continue to funetion pcoperly,but is mercly an opinion ofthe adequary ofthe system tmderenrrent conditions based en the available
infocmation.
� o�
O _�.y:; O �,
,�:��1��,_-:� � � CITY of ORONO
I � ��� � �
� � �� ���� ti NiunicipalOffices
�'' ,�.-'�„���,� 'ti
�� �i' -�{1 ���`�°.�G Street Address: Mailing Address:
9 ''�. �U` g,
$'EggO 2750 Keiley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: ���,� ����n�' Address: 1820 Fox St.
-r
Permit #'s: nona 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,
construction, and location. Appears to be operating properly.
2 Compliant 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 and is functioning properly.
� Non-Compliant 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 drainfield and the saturated soil level.
(The saturatad soil level [�] has or [ ] has not baen idantified at this tima. If the
saturated soil lavel has not been identified, this classification is subject to revision.)
ANK CONDITION (5-9) : 5
5 Pumpout not needed at this time.
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.
9 Inspection pipe is located over tank baffle-can not measure solids accumulation. If tanks
have not been pumped out within three years, they should be pumped out now.
(During the last septic tank Maintenance Pumpout the tanks [ ] were or [� were not confirmed
to be watertight by the licensad pumping contractor. If the tanks ware not confirmad to be
watertight, this classiEication is subject to revision.)
D AINFIELD CONDITION (11-14) : 11
1 Drainfield is dry, no surfacing evident.
2 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 separation is 0 feet and the system is non-compliant. Repair or replacement of the
septic system is required by 12/31/2000.
�-a�-q�� �' �---
Date of Inspection Sep 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 � � ON–SITE SEWAGE TREATMENT
r$,, �C�, INSPECTION REPORT
'C�� G~
�
9kESH�4
Owner: ����� ����✓�� Address: /(��� ��'� ��`
Permit #'s: p�fr� Dates: — Contractors: ///7K�Dk/Y�
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 belou.
(This is � an existing system [ ] new construction)
SYSTEM CONFORMITY (1-3): �
1 "CODE SYS7EM"-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 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 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 which is failing for any reason; and an s stem with t an 3 feet of unsa rated soil r sand
between the distribution device and the ' �cs. � ',r � , b �a�
�'-� � U��` . �/
(The limiting soil characte�ristic 17��has or [ ] has not been identified at'this time. �f the lim5ting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDITION (5-10): �
T inspection indicates:
5 Pumpout not needed at this time.
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 within 48 hours to eliminate surface discharge.
9 Inspection risers missing-tanks could not be inspected. ]nspection risers (4" dia. pipe) must be installed in each
tank at next pumpout. If tanks have not been pumped out within the last three years, they should be pumped
out now.
10 ]nspection 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 (11-14):
Dr,at�nfield inspection indicates:
(1y Drainfield is dry, no surfacing evident.
�'f� Some 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.): � tlf i
COMMENTS:- �
S � Q� c` ��[i
' .�r
�, „ 'r�
s-
ate of Inspection e ic Sys em Inspector / �
/���—r���
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or o er 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 location and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
CITY OF ORONO � O�
Municipal Offices O � O
Post Office eox 66
Crystal Bay, MN 55323-0066 � � ON—SITE SEWAGE TREATMENT
r�, � INSPECTION REPORT
'C�t G~
9kESH��'�
Owner: �,YUr�Y'.� 1/,U✓�l'� Address:__1(�.04 � �X �-I,
Permit #'s: I')'")1''t'_ Dates: "— Contractors: //1��1^D1,�✓'i
City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
7he on-site sewage treatment system at the above address has been inspected and appears to fall into the category
checked below.
(7his is [ ] an existing system [ ] new construction)
SYSTEM CONFORMITY (1-3):
y�
1 "CODE SYSTEM"-A system which meets all the location, design, and construction standards of the current City
Codes, and uhich 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 seuage input without discharging
any pollutants into ground or surface uaters.
"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 which is failing for any reason; and an system with less than 3 feet of unsatu
� i between thP �!��•-���•�^^ riP�i,�g and the limitina soi ics '� „ 'y � r--
�(-��� � ��'�'��r lo��-��._
' �`- (The limiting soil characteristic � has or [ ] has not been identified at �this time. If the limiting soil
characteristic has not been identi �ed, this classification may be subject to revision.)
TANK CONDITION (5-10): �
T� inspection indicates:
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 punped out within 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 p�xnpout. If tanks have not been pumped out within the last three years, they should be pumped
out now.
10 ]nspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
If tanks have not been punped out within the last three years, they should be pumped out noW.
DRAINFIELD CONDITION (11-14):
qFa"�Jnfield inspection indicates:
l]X 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
immediately. Repairs must be completed Within 90 days.
14 Drainfield extent and condition unknown.
LIMITING S1TE FACTORS (slope,setbacks,etc.): �
POTENTIAL FOR SYSTEM FAILURE (depends on soils,water table,etc.): ,���Z�
��=—
COMMENTS:
1
Date of Inspection Sept' 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.
7his report must be kept on the prE�nises with the system locatien and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
CITY OF ORONO � O�
Municipal Offices O ,� O
Post Office Box 66
Crystal eay, MN 55323-0066 � � ON—SITE SEWAGE TREATMENT
r$,. � INSPECTION REPORT
'�� G~
�
9kESH�g'
Owner: ( ��I✓�.S /%',(�.fy'�l-� Address: ��( ..J7-
.
Permit #'s: e�F!.�I'1�, 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.
(7his 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 waters.
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 which
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 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 uith 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):
� inspection indicates:
Pumpout not needed at this time.
Solids accumulation in tanks indicates they should be pumped out this year to help prevent future problems.
7 Solids acc�unulation in tanks is at a critical level. Tanks should be pumped out as soon as possible.
8 System is discharging to the surface. 7anks must be pumped out uithin 48 hours to eliminate surface discharge.
9 lnspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
tank at next purtpout. 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 g'ive accurate measurement of solids accumulation).
If tanks have not been purtiped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14):
Drainfield inspection indicates:
11 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 within 90 days.
� Drainfield extent and condition unknoun.
LIMITING S1TE FACTORS (slope,setbacks,etc.):
POTENTIAL fOR SYSTEM FAILURE (depends on soils,water table,etc.): ���
�tui G?')'""-.
COMMENTS:
� � „�-----
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 current conditions based on the available
tnformatton.
This report must be kept on the pre�nises with the system loc�tion and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
On the North Shore of
Lakc Minnetonka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
1335 S. Brown Rd.
� � � Crystal Bay, MN 55323
473-7357
OWNER �`�?C�Y'�'r-'-S /v� /�//.1V711� ADDRESS �O�C� J�(�� ��i
PERMIT NO.'S. � DATES � CONTRACTORS `
City Ordinance No. 210 requires that each onsite 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 all respects relating to design,construction,and location.Appears to be operating
property.
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 ma�y respects relating to desig�, 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 nuisance.Please contact the City Inspector to discuss system repair/
replacement procedures. If drainfield 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�nspection 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 in tanks is at a critical level. Tanks Dra,i_n,field inspection indicates:
should be pumped out as soon as possible. �4 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 elimi�ate 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 drai�field. 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 for
❑ Slope (depends on soil types,water Future Expansion
❑ Soil table and system conditionl � Adequate
❑ High water table �Low F�-Fair
❑ Lot size Medium O Poor
❑ Lake,wetland,or stream ❑ High ❑ Inadequate
❑ Drainage ❑ System is causing visible
surface discharge.
/7 1 / / [ -/ �/
C�MMENTS: �i� �/1� AI�C_�' /'�C�✓[�. ,U�PJ�I�CTIT:iP<�'�L/� �P!'L�t�..! ! ��+ ���llC'
��/��/�� ��R I J�(%�� C�L1� `�ITI:.
/�-��-��
Date of Inspection S 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 conditions based on the available informatio�.
This report must be kept on the premises with system location and pumping records.
WHITE COPY/Inspector's File GOLD COPY/Homeowner