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FRUhi : Panaecx�f c FAX SYSTEfif N0, : 612 '7S3 6222 Deo. 11 26i2 11:iSAbf P2
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" :. Minnesota Pollution Complian�e Insp�c�ion Forrr�
� Contro��lgency
520LafayatteRoadN4rth �x�sting Sub�aur#ace S�wpg�Yre�tmen�8ysfem�(551'8j �
St,Pau6MNss�ss.a1FA instructfom vn page 7 �
• Pgrceinumber. 1Q-117-23.21.0008 �Qrl.00al �
• 'iY�ddnB Purpc�ses: I
Systam stptus; �Complf�M p Nonopttlpll&nt
{besedOn dlCo!»pllarrae naqup+ert»�ta)
SUmmary aorm �
Pro�erEy Infnrmation
Property owner Mvne{sk �I��Iqy IneQecltons&gqr�eul6n�, • �
F'ropattyaddteeB: __..$1fl6 Ftanoh l.ske Road,Otano,,,_MN 6s381 �� ��
PtOQetly t„Ntl@I'8 Addt�168(itdlffwanl}: E2�Jsbk��vlNs RO�ttd,8uite#200,W� l9t,pA t8474
Gounty:.�ennealn ,,.,,,, prapany owner pf�bna: i�/l Petm1H(ng authotHy: C�(t „o(Oron,__o ,�,
oate ayatem�stn�cteJ• .,�ti28tofl f2aaaon ta tn�peauon: �,oint of seAe - -
SySt8n1 D�S�MtptlOn _
BNat systcxn ds9Ctipttorl: 3-1060„�aq�A=sepflo fe�kg d�l�63'x 1�pregsurixqd motmd rock b�d
tocalpnmjit t�umb�r� �20Dg�008f8 _,,,_� Numbet of•be�lrpor�ts;6�,_ i)oslgn tk�w�t8; 7�n oaa
._-.---,-.._.•.»
la�tha syatemt
fn Shoroland area? �Yoa p No !n Wcahe�d protgotbn ArnA7 p v� p r�o
An U.fi.�nvGonmuatal N,atecNon 8ystom aervlp�a Nunnesota�syartment
AgenCy(EP11}Cless v I�yuCtlGrt Well7 C;J Yes} �No 4f Heaih(A�py)Ilcartaed t&dGty? �f YBS �A!a •
Camptiance 5t�fus�raas�a,a�to�oym��m�ss��edaaa�,�i to�raqu�rer,�►t&mar���p�r.)
. Hesad on fhe tnfameUon�alltefrkl shd teport�g�qt»!!ao►iod fonris,lha oatttpli�iae stetps o(th�eyatem ts(aheok one):
�l CertUicsta ot Comp9anoA�vep�i u�tll(Syde!as irom dela of ropat): �
L��tailae of Nonoompllanoe.For Nonoompl{an�t 8yetema: �
'�ha reacon fur nonopmpNance te: � .
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'�his aanrsqmhUan!ryatem ia�otsreltt as ahquk ono valpv�; '��—""�`
C]Imminent U�ro�►to rubAo h�tth&ee��r ���Ifng ia{�notea�$rovr,d vrater ❑IVp�l��ort�pgarlC�yAth pper�llnfl pamtlt
Gsrtificbtinn tcanp�o�ed tarm muat i�a subniHted to ihs+oce1 wdr ot governa,encwUidn 1s days.)
I he�vby aill�'Y fhat ell tho»ecnaeatylnlamalloj�haa Goen gatkarud fo dotomtMB�he oomp�nca etatus ol thitr syatem.No
detelminerlon oJRXWg aystem pertolm�nDe has beeln noroan be m!u!e d(re to vhknoVm COh�l7ara dtlJfifg system COAsltuoflon, �
po=slWo obt�ea of fhe aysfvm,inetteqr�ato meln��qnco,arfi�fmg Wetsrusage.
Namn: _Mark Tredwrell _.w..`._...._ Ceititic�ibn number �12306 �
. eusrnesa t��nss,wmo and npmber: T►n o aot�_TesAnn�07 ,�,�,�� .,,��� or
Namv of looal tmii pf q�rern k cl of anp
8lpnamre: ,,�,. , Dat� 1_ yA�lt?�, --
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�equired Attac�ments ; �ngr�orcan�ra�o:�rt����ngpeaiEan��por�is�aa��e�o�y�,. �
C�Itsqy(c anmp�loqoh toYnlo ARnohl;cis �I Hydrau�ia Pmfamenoo. 1�Tank Intogit{y. �-eon SoyorAl�aA D Op�re�hW�l�CrmU t'orm(It ?}
� appNoabb) •�3yslem+kA�Y glAkbtdR dtavriny Ct M�lssseemeM al�my looal reqWremehts Ihat pto�Sttereni trom whet(»raqi�ked on Mb � i
torm i�soUewiqp�epa �AflendonmonS;am(�fepproprlalo)pWwrin�o�nlayob(qsq: ]
p{JYNtfe 4�qlll!'$ltlent6( tiv ornMfnn. hf.8i16.GW/HArvnu�erufbnaftop�ohogJrhwlda�re4'(lIYNIS� botmw oAarodao.n�pbcut•cr `
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/ls�uso0faao{�Etnuadwflhtr�MnrtwnUsNrepolptclthl: orx�Rbp+esMrfarpypyK��lpykauadnsoow!►atnay�elsna,�toProtcctprtxn+d
xvbr.lho syatan mwtbo aypreara,re�w�oaf,orqsuas4.rhonnYn�¢r!H�ll�fit NaemD req�►4rdAylocNt,nxno4c�x den ex»f¢,p eyo�wn k twt�+fny us�brl+sotr(A i
ldw,urxlhea atlunxl AW kolvf4osylnaaNbonalataa+,NvnXasyaMmmrdrtot be uP�udcd�ro�erlts+no cSvCOAanveu mnyT�v�l�pudy
►oaolarrnoncoamrmnwaardcLndsµ�r,w�rskosno(ayp�ytosyep�yslnchor+w�uanar•, n+o.�ora,oeonpd)nowre�+bnwr�hroodj -
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FROIi : Panasonic FAX SYS7EM PH(3NE N0. : 612 753 6222 Aeo, il 2PJ32 Ii:iE�AM P3
Parce!number, 1U-111•23-21•0008_,�,_^___.,�,_� 8ystem s�tus: �Canplfant �]NpncomQlisn! �
. • ras determtned byih�form) �
�yf[rau14�perfor�n�n��s�nd dthar Cnmpll�na�
CnmpNance Issue 111 af 4
E�ate of afne�wrflton: 1�lp3112 ._,,,, Fte�s4n for nbeatvatlan: �alnt ot aate
7ht5 farm expirea upon next in3p9clton or in thres,y�rs,whiohever ocqire frrar. �,,,� '
Compiianas que�danslcr(terlac t�equlre� ' v�f►�ae�on Met�a�":{o��on��y
�4heok fhe aapmpJfat box ,,,t,_� •{Cheok tha ApJ1�pp�iste box)
t)oea ii�e s atetrl dI80h�t�e sswe fle to the L;Yes �I�a (� 8eerohod for aWfaoo outkt
we
AtOund au a4e� .
Daes kfi$eystem dlsoheqte eewege�o drafn (�;Yes �J iVo C� Pertotmed hydreullc tost -
f�or surfaoe ars� . _,,,, • � SoarahRd for seepin8}n y�rd
Qoes th�9y�tvm�use sewwFspa t►npkup w. Cf{Yes �A!o � Ch�oFced tor backap In ho�r►a
I�s dwaRlna a ostabllshment9 �, ❑ �iCQg9jVe�dl�g I1i sp0 Ey9tA111/L�.�ibXB6
Qo oiher alluaUa�oxlsl ti�ei haVs Ihe ^ CI;Yae �No � H��er E4eUmnny .
pokentipt to immed►ately a►�d advatseiy
fmp�ct ar threotnn pubNa healih ot'esteiy : (� OtemSned fdr surginp In tqnk
�e,,,et:trk;83,ansate oCYel's�eta 7 , ,
Any°y�a„onswar thdloatea that thesyafem 1�ari Immh�em ' Q 81aok sWl'nboVe oolt�ispersal systeln
t6roat t�1�ubUo hoaTth ond ealoty. � L� �ystom raqufrea'emerflenoy'pumping
• - �-- 1� PMfarm�d dye t4�t
Doos ltt9 byatem pose a thl�eat tb 9t�puf�d [];Yes �!Vo ❑ C�h9r.
wAter for dry�odpclfltone deem4d nan- •� �•
.PrqtedNe es ddtetmt ed b the(n8 eatoft ._.^,Yn. w
"Yoe"1ndlca�Q�thaf tha aystom!�,f�lling to prQlvot
grouna wafar:Jt"ys�;descrl,Gs th�cond►von 1�otad: """�`�""' -"
' '"NIO�Afld�d pfnlaco/9X(�18.7Ms Ilsr 1a�m!oxh�usrJva�
' _... Lt sequeMlal oro►e�,aordoeslt di�7oe�e whkVt
��,� ' combinaNvna oro nec9seary to rnoke tl�ls datom��i�sthn.
---.,.�.,..�.----�.,,... . _....._..._.—_..
Certiflca�ton
Thia lam�la to ba Compl�tai and attact�ed to thp�nmmary�am of tho MlnqesQta�PdluUon Cantr4l Aqoncy's(MpCAj Cosnp3laflc�
InepeWian pom�tor Exleting SuqautfaCo 8avr�ge i?eaLnont SyaEama.Abse�vattoue,IMer�rel�dkme,end conClustvns must iw
Gompieted by en inspecEor.Gomp(nked fwm tfi►IAt Yrx eubmAteci to th�ic�l unit ot governm�nt wtihth 4a tl�ya.
Prop8lq�ownor rp,me(sj: Fide1 .1i1$I?�atlohs&Congulting -- , -
.,w.--.,.�..--._..�__..
proper�sddras�: �18&French�.ako Rn�sd�or, qn�,MN Bb391 .��,
Propeny w�mara a�ctreea�rduror�nq; G2o�ackeornl9e Road,8utte#2od,Vyarmineter,RA 1A974
. County. e ne In -- - -- - ...... Phoi� NA .,��
1 h9reby oslilfyll��I pp�otrplly mado(ha�obaon�ellong,!»/nlpl�taBona,�rd cwnah�alolte ropated t�n tbla tant und fAei Utey4re
OG!'J1DOf� � f
Nrxna: Ma Tradawall � � �erNBcsltot►number. {1230j3� ---
'Businecs Itcanse��anle end numbsr. 7radewell�I TegUr�p,�30��:. �r
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-Nama of locql unN oF flova en� c,{t� of arvno „, �M�� ;
sl�nuEure: t^�"'�i,�� �'�;� , Date: i2l„�j1�. ,�.--�—_ �
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FROM : Panasonic FAX SYSTEM PFi(]NE ND� : 61� 753 6222 Dea 11 2fdi2 1i:17AM PA I
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Parcei number. 10-117 23�21�0006 �,, syste�s�t�; �Compqanl p(�oncompliai►l � �
- fa�av�arm�ed bylh�s t�m1 ,
� M
Tpek In�egri�jr and��tety QAmpitanco
Campilance I'ssu��2 of� �
Date of abaerva�an: 1Zl07/12 .�, fte�son tor abssiYatkN1: polr�t 9isalo
--.-�----,-�—.�.
7his torm e�ires on(lhrou years); ,�,
aompliance ques�onslctl�r��c(Requ��d) V�r��ca�On Meth�d�;(Opflon�ly
1chBcrrrh$�����re b��. .�. •�Checkthe eppropriafsbax)
Doea the�eyat�m aanRiat ot�seePaye Ai�. ❑Yes 6�No p proyeat tank bottam
C@B�pOpl,.dryWEU,orleaohl ? •
Ao any sewaye tsnk(s)tsaK below thnU p Yes �No � ��erved tav qquld leval ,
des�g,ned opetxii.re�d4pth? .._..._�„ .-........._. �81 �Atntned oonckuction reoords
ltYas.identiiyv�JJ�.ohsewepe CI h�Can�nademPb'tWmpad�fank
tunk leak8. .�,,,,,,,... ❑ prpq�t p�t�►de tank 1�r•blaak SdP
Any'yea"enaHrorina�lom(qs fhAt fhe ays�em f�fn�lfn(/!o pr�taat
yraund worer: L� Pressure/V�cuum al�oak
; 8ee�e pita meepug 700o.a55o may ue canpDart ff atowed d P�her T, �tlll(6 Pumoac!and c�eanad an 1 T�IQ /1�
in�rdinanoo by iocat perml�n�aulFwri�. T�nk��ond§ames in pood oondf�ion
"h�stwrdaN proto�ol eklsde.'rirle Net le nof trxt,au�tiyo,i»
sequentl,�o�der,noor dooslt lnrpeato wA/otr oomWrroUonp
ero naceasery to mako iMs dslomJapqod.
$a�Aty GMB4�c
S� Are�Ay Mxintaenenoe hde qovets damaged,cr�kad,a appeared!o ba�Utictur�lY t�sountl7 �Y68` �T�o
2, Wero�U meln4enanos hole oovere r�d in R eso�ed roann�r{e.g.,alt�c,ewa raMncod�� �Yes [J No' �
8. Was seoo»dary uooesa re�tratnt preaont(eafotY��,�o»d oovar,oresio4y nolBn�.-IJqhly recor�mandod. [�Yoa �I No
4. Wa9 nny othot safalyM�qith batw proaent'I }�YsA' �1 No
�xplaln:_,—�..».. ..-_ ,.. -- ,- _.. _-- --..-.—t.....� . .
'$ys�om Is an lmminant(hn�t co publlo heahli ancl eafe;y, �
Ger�iflca�ion � �
This t4nm is to be opmpldked�nd ettaohae M th0¢umrnary�qrr1 oI lhe Mlnnesoia QopWwr Conprot Agenayo(MPCA}Cbmpttanoe
Inepehtlop Form for�stlating 8ubsoH�Iag'i98waqo 7reatmsittSyatatrin,pbse�vetiwis,Intorpratpqons,and conufuslbns mvol bo
�oompleted by nn tna�n4tar,r�lntatner,a Se►vlca braNidar.�omnleted fam must be eubmrited to the loo�l unitef n0�mmment withitt
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Pwperqr awaer nen,e{s}: �tde k�s eollons arcalsul ,�,�„�„�._^�,. ��
f�roportqftddfaao: ;t7a9,�redCh ta�ce Reed.di�vho.�!N 6599,�,,,
..,. .--.,.,,�.....�.
Pro�edy qMmar's eddtes2 Ndlfteren�; 6�$JaolCeonvfjja�Jtoad,Suftu�20D,Wartrdnster,PA 90879
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�►�Y --tionnepin...-.�., ,�,_.., Phone� NA �
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1 f��y oer111y f/��t l parsoneAy m�te fhe obsorvallnn3,h�ta�retatbng,�►�d c�r��u�ne repatvd on thls lam and tha!fhsy'n� �
ta�n� MeikTr�bB�van�. — --- - ....., Certtdcanon numbsr; �oa �,�.,,... � `
•B��slna��llCe�isenameunclnumber, 1'radewe�,�{�17os11nat�:i07,w,,, � _- , ��� �r ;
. f�emo oi•iooel tmit,of flnvern nh Ci► o Q_I]?.�—�-,.,�,,;:---�:,._-.:;. ' • - ' - �
$)glfaiar0: �=���C�-r � ` Ueto: ?JaIl12
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FF20hl : Paatasontc FAX SY5TEP1 PHONE N0. S 612 753 6222 Deo. 11 2012 11:17Rhf PS
' �
Parcel numb�r. .�0-1�7-2�21-0a06 ,,,� system statuac �compNant p Noncomp�ant �
� (es dete�n�lned by fh�lorm) '
$oi{5ela�taticn CpmpH�n���nd O�h�r�qmptlan�� I
Compltanc�lssue#3 of 4 � j.
t�te oloba9tvaUcn: 1?,�/8�J12 ,,, Re�soA fa obsetv8lkm: PoIM bia�lo ,.... .,,...�,.
rhle Intormatlon a�fhis lorm�aes t�at expJrg. �
� Compllanc�qua$tlons/o�iterla;(Requlrad�. Veriitcation Mathbd'";(optiona�
___ _(Check the approrNl9ts b4X) (ChvpJ(tt�e spplaptlale bax}
For eyetome bu�t pdor to Apr111,19fl6,and nat : � Con�Woted sog observatton(s)�altaab Ba�ind Icne)
' focated in 8horefand or Wetlhesd ptoteotlon
Area or not�ervinp e fooa,bBv�sr�o or � G 7wo pt�ous verUkxdans(atteoh bodnp Ioga)
Iodeing establtshmen4 � 4��� ��
fJ08B NIA 6y6fAtn lypya a��88819 fW0•tUO�
vo�favl sQpara!!on diamna�e,from Perlodtcdlly --��--��-------
��f,¢�i 649 or bedrook?�.� Y�s ,�{o_, _,,, ..�.
Far non�pedormaraw sysiema bufikAptfi 1,
� 1996,or Iatei or for nan-pertwm�nae eyetems g�t����� ira Prevbue obsant�fians
looeted In 8hcrefarui or Weilhead Proteat(on b hyq In�apvndent �1�a sufflcl�nt,unlese 6fte
Areqa ar aerNng p food,baverana or tbdginp oondAlone hs►w b�aRered,
wtablishmonk
p09s tho Fystem have a i6ree-fnM verflCat '
ses�araaor►�stflnCe from periodk�i{y estutatee ,
8011 or hedrooR7` ,,,, Yoe
Forraduoed eepnretton d{sfance aye tems(l.e.,
�pe�ipmkuio&'systeme wider�d 7b90.0979 or ' MaY be►eduoed by up fo S��aohf H xNNowotlln lacnl
Type IV or V system under new 7Ui�o.2350 nr ' adlnan�e. •
7aaoa'�oox �ND 9(krld8f(I p/W000107lJStS.ThIV IIA�/81JOf 9XIIBu6IJV9�
p06s iha'system me�t the designed va�looi �►8�1�M��►��,nor doea i�lndkntn wltbh
sgparaUon cltetence frwn pertod[caIly setp�ated �ndln�neooaesry to make IhJa
so8 ot bodrack7' Yes No ,
AnY bno"apet�el'lnNloates tl�$t fho�yetolls!s ti►ll�ng to proLoat
�round Wa�at
Gertificaxlon � '
7his famt is to be com�l0ted and sttechad to tha surnm�uy Fc�»pf tha M'iAn�eota PolluHon Controf Agonoy's{NIF+CA}Cornp4tnnav
1»sp�ton Form tar pxi�ting 8ubsuMa�e�aw�'gg Trffet���n!sycEemu,Ubseivalbns,Interprefatbns,and cn�tiCiustons mi�t b�
avmpbted by an Inspector or daslpner.Comp[ated fann muat qn submlRed io the 1vca1 unR of g�v�mmarit v�htn ib days.
Afopetly ownAr r�me(s} Fldelity fes�Qgtf9�e t�Ca�sy,��A
_-.�-�,.....
propeny addrese:15 Frenat�Leka Rc�d,ffr000,!AN 85$p9 .� �„_
P�op9►ty mmer's nddtess(If JUferonq: 820 Jr+oHspnvtlie Rt�d.8��,1,t,a t�2p4.Wermindk.pA 189Y4."�..��
Couniy, Hennepl.n w _. . p�one: NA „�� - - (
1 ha'oby ceHily thot 1 por�aruby tnc�da tilb obeervaUars,lqtorprdtetMns,ar�i condnafons►oported on ll�t�fon»a►td thDt they sro E
oOrrnCi. • �
1�emq:• Mark'lYtiQewell 4__. Ce�tl@owk�nnurttbar. #2�oe ' , �^
6usinasa llcnns�name end numbar. �' dowol S,�il_rQaUn$#3U9 ar �
t�a�,o oftocp►unri nt gover enl: Cii .�� ��
s(gneiura: �rt�.�.rC��.,..� . Date: 12106li2 ,� • . .
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FROi'I � Pa►iaisonfa FAX SYSiEM PN�IE N0. : 6f2 753 6222 Dec� ii 20f2 1i:18Ah1 A6
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'r�•ade�+ell sa��'�'eshng � '
ls�3o �ah�ia s�rect Nw �
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Ceda�r,N�l�t 550�.1
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Aate;J?ecembax 6�',2U12
Name;S�iddlity Tnspe�tiqnS�Cotisutt�ng
Addroes;2i93 Frenal�Laka�to�d;Omno,MN�5391 �
SOrG BU�TO TEST�t'4�tT •
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Hoi3a #�1 Iiorlu'#� Bok�n #�3 Boi�tn �f4
0"•�s'�opsail �
I�o�un
10'YZt 2/1
�„-14�,
J,oan�/S�ciy�oam
�.SYIL 313 3/4 .
� 14"-30"
Nina Sarady�.o�qa
7.5Y�t 4/4 •
30"�40'>
Medium-k�ina Sand .
1DYIt b/3 6/2 �
Mattlea @ 2G"
br I�ol�
Bet�vlun�srk-Top of ex3ating see�:�ond tanlc 104.0 , ,
Frabe#�1-Sur�ce elevation•f 12A Hottom ofraok vlav�tio��-t 0�,9 �
Probs#X�Surfhce elevafta�-11�.5 Boftom of rabk alevation»110,0
23oring dbl-SurFace elpvhtion-107.5 Mottl�cl suil�evatiot7�I05.3 4
Separattou ueecleci��b" �ave�G"+ Saparatiah olc�y. �
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FROM : Panasonlo FAX SYSTEM PHUNE NQ. : 612 753 6222 Dec. 11 20i2 11t18AM F'?
DYC-0$�=�IZ �aS��SY7 Ftppr�ITY OF ORAI'0 195;;IQ4dl6 T+007 P.OQ'!/QQZ F�11 +
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C1TY C�� IN���'�N��NC� �'(763} 479-U527 �
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Insptcier����. F2�ildirq Permtt No,„��' � �
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Prcvtrrtv Address�-� . Gt" �ot Butt�nq-.-�,,.,.�E� -- . --
PlumhinF ConiYBdtar-Cluts[da SowAne t7hpaso)�-�._„�.�+^�.��._...,,..,.r._ �
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Nropsr Ou�ld�� lntoi� '-''"� .�_.,,...,..�.,.BafFh Pbtes? '''�
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Tot41�vnpth ot�Ine%....' �rL�� Num�or of IMes----- �
TvEb uf.a� .....-+�._..��'�- ----P.Rw�Aaon roit....f�� �/ t"�w.,.,.
Wldth Ot tt4ndt lypo o(Aiter m�tarl�l.�t..�.�,,,,,.t
Amour�t of iil�ot rAatvrial balow i1nB �� ''"'�
Uapth from to¢at ti1010 itetthed g�adt ,�,Y�'------- - - - ...,_.,.,,_,,,,,,,,.,,.,-_-
4huok VOnq.�,...�..,,.�r _ _ -CtNWk C�Ulkiqp .��.�r
Cheok Orade tn Harlrantal Wae�a Piyos,.«,..�..�...�.......�._.."''��.dc�an tfuts "��
Tonege or Yotds o1 f�ilter lauorlat •,�•'��To�i( Sq. Poot�qe af proln pIo►d_�.�,�V..,�,..........,
eami� -�� .1� 1�� � ...., — ---n� f p�c+� —�- �,--.....,
�
ba•�4�1 Bt:Q ai Movnp SY<sam��;�.6k�at lNatmd 6�rttem Rovk Pilta MOterisl���
4rew detoikd dlopram io seale wlth tlteawremonte belpyv.
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Instructions on pa�e 7
Parcel number: _ For Local I racking Purposes:�
System status: ❑Compliani rloi�compliant j
(based on a!I compliance rec�uire en s)
- ,u��
�i 9��;+:�f �ii�Ci�;id�?��:.`�
Property o�Nner name(s):
Property address: _� �,f' y�lG L� � ��,, D�1�,�� ��,
Property ow,/ner's address(if different):
County: /�Cs✓,� Propert;�o�roner phon2 Permi ng authority:
Date system constructed: ��.� Reason for inspection: S,Q��£..
��tei.�'``r ��tm, : y.��� --
Bnefs;�stem description: � /,d KJ�f r" _�_ ��
Local permit number: PJumber of bedrooms: _ _ Design flow rate:
!a 'r.Pt�sys'i�;-::: ---_
In Shoreland area7 ❑Yes i�!o In!�!ellhead Protec�ion i�re�7 ❑Yes �Jo
An U.S. Environmental Protection S��stem serving a c�iinnesota Departmen't
Hgency (EPH)Cfass V Injection Vl/ell?�Yes iJe of Heath(IYiDH) licensed facilify7 I j Yes � i�fo
Y:--� -=:�'=� `� �`-='� (gased on state reyuirements-additional local requirements may also apply.)
Based on the info�mation gathared and reportec!on atiached fonr�s,the compliance siatus of ihis s,rstem is(check one):
❑�ertificate oi Compliance-valid until(3 years from dcie o;repor�i:
�iVotice of Noncompliance- For Noncompliani svstems:
I he reason fer noncompliance is: pg.(j _�,dJ Q �/yS Q, 5,,,,,�,��v,� o RG� ,vG
�-. i�-;c� �.:� � �as:�.��scl�r�i;__- .� �. —__. ------ -------
, _ __ .. .,, _.__ .� _ � e�.s �
❑ Immrnentthreatto public health 8,safe�y �ailing to protectground water ❑iVot in compliance�r✓ith operatrng permit
.,d, � , __.;'di"� (Completedforir� mustbe subir�itted o the local unitofgovernmentwithin 15 days.)
1 hereby cerfify that a//the nacessary i��formatlon has been gathered to determine the comp/iance status of fhis system. No
determir�atior�of futum system performance has been r�or can be made du�to unknown condrtions durrng system construction,
possible abuse of the system.rnadequaie maintenance, or future vvater usage.
� f
Name: �������y��y� Certification number: ____7�b
Business license name and number: � � (,v,e5_f__��'�`�_}.�� S'rK. ,� � ` o.,
Name of local unit of govemment: D.flB
Signaiure: Date: _ 0 i p g
—�
x ��� �. � .< inspector Complete: ns- ... �ecii�;z ;���ert is _� , i;�r,r�.
':� �y � � -
ChiC: �o;+'uiia;'C� ioi';'rS�;�iz,�;1.t: �Hydraulic Performance l�Tank Integrity �Soil Separation �Operating Permit Form(if
applicable) ❑System drawing/As-built dra�roing ❑An assessmen�of any locaf requi ements that are diff re t from what is required ot�this
form ❑Soii Boring Logs ❑Abandonment form(if appropriate) ❑Other information (list):
�-;'-�I:'<;='� i'<',?i?i'�i71e�iS (derived from�blrnn. Stat.§115.55)An imminent"rhreat to public health and safety(17PHSJ must be upgraG�J;replaced c
rrs use drscontinued v✓ithm ten months of rrceipt of fhis noiic2 or within a shater perirxl if r�uired by lo�al o;drnance If rhe sysiem is iaiGng to,orotc�t around
water the system musi ne upgradec',replaccJ.or its use discontinued within ihe time requir�'by(e:al ordinance If an existing system is no'r failing as defined in
laiv.ard has at least i�:vo feet cf design soil separation,ihen ihe sysre�n need noi oe upgrzded repaireU replac2d or rfs use drscontinued notwithstandii�y any
Iccal ordinance�hat is more strrct This provision does noi apply to sysiems in shoreland ai zas. Wellhead P�oiscfron Araas,or tnosa used in conna;tion�roith rcrxJ
beveraye.and Icdging establishments as Uefined in la�,v
rvq-wwisis�-3i Co;n�tianca lnspecf-ion i=or;�n for FxistinQ SSTS
��l'l 08
i-'�i�'�� ilUl"!IhEI": — _
-- �-------_ System siatus: U Cornpliant U Noncompliar�t
(as clefermined by this form)
. � � ___ �i��a�� .� �-S'i , i:c _ + ..�:��:=_-
_ _ ?sa '�aL!a �` ...
Date of observation: Reason for obseniation:
This rorm expires upon ne;:t inspectio�i or in three ;�ears,�,vhichever occurs first:
Com�li���ce qu�s,fo:�s/criie;iU: (Required) tie;ii'icaiic�n ivie�'hoc;`: (Optional)
Check fhe a ro riate box)
--� (Check the appropriate box)
Does the system discharge s�wage to the ❑`(es �o
round surFace? Searched for surface outlet
Does the system discharge seU�age to drain ❑Yes _ iVo ❑ Performed h;✓draulic test
tile or surface�,vaters? �earched for seeping in yard
Does tiie system cause se�r.�age backup � ❑Yes No
❑ Checked for back��p in home
into d�n�elling or establishment?
-- ❑ E;:cessive ponding in soil s;�stem/D-boxes
Do other situafions exist�haf have the ❑Yes No
poten'tial to immediately and adversely ❑ Homeo�vner testimony
impact or ihreaten public health or safety
(electrical, unsafe covers etc)� ❑ Examined for surging in tank
�'''�„,",Qs a �,.,� ir,-'ica�es r>,:. � s��--; • ❑ "Black soil"above soil dispersal system
: . � � -.-7��>e$....3f $�.7 IIJ`P'')i?�/�C
eheezf to prjblic f;2alth and safeiy. ❑ System requires"emergency"pumping
- ❑ Peifion�ned dye tesz
Does the system pose a threat io ground I r"es � n n
� �r�o �( Oih�r� /Q�ll sc wFJ/ A��%
v✓ater for ami conditions deetned non- ' � r � S
protecbve�s determmed by the inspector? +I q�( �y ��� / A'(
� - -- — __ �—
,`;�c.s ;-t,rr F :�c��ilw S;iSYe;i;15 7"2fI%I7C�iG f�1'OlEC; ----
,'1'Qfl!+f���<^Yr,' iT"'7�S",r!nSC„17�? Y,Bg COn4.'iilOz4 t7Q7:6!�r' — --
_ _ __ `No standard protocol exists_ I his/isi rs not e;<hausiive.
----- --— in sequenrial order, nor does it indicate �ahich
-- __ combinafions are r�ecessary to make this determination.
�:. �: ..�_�...�"�
This form is io be completed and attached to the Summary Form of the iviinnesota Pollution Controi Agency s(iviPCA)Ccmpliunce
ii�s�ec�ior, t�r;�;or F,is�;;�g Subsur���_ce Se�,v��g�Tr�at�nenf:Sys�ems. Obsen�ations, interpretations, and conclusions must be
completed by an inspector. Completed�orm inust be submitted to the local unit of government within 15 days.
Propert;✓o�vner na�r�e(s';:
Prcperi;�address: �f�� ,y� „�o� � s7�r ---
ir
Property o�r✓ner's address(if diiferentj:
Co�mty: �c.4.` Phone:
/hereby certify ihat/persona//y made the observatlons. inferpretations, and conc/usrot�s reported on this form and that they are
correci.
Name � �,.�,v �___�_��� Certification number: ��
Business license name and number: /yjiS ,`,d
- �' e 5��� � Z/ or
i�lam�of local unit of govemment: O �,�
Siynature: --fdc` - - - — - — _ Date: D i /p ---
f�--
wq-wwrsts�-31 Compliance Inspeceion Form for Existrn� SSTS
�l1/08
�'ank I�e �
Datt,'• O�tr,ber 1 � 20G�
�Imer J. Peter�on Co.
5921 D�gtae Ave.
Delano, MN 55328
Phon� �'�3�972-�420
Fax 7�3�972-?21�
:>1�5 �`re�,ch Lake Road
Or�atlo� �`�IN
Baffl�s: 'rON I t�FF
Tank Cap�ci�y: lo�_� c�t��lcn.� eaet�
# �f �anks: 3
Type of Tanks: -tE���t ��,�,�zPt�
�a�l�O�S: 2500 ya.11on� pumpeci
Manhales tc� Grade: YES /�
�..._�
Commen#s:
lst ;.tank �nc� lift stati�n thLu ,tianh�.l,es
2n�� t znk �i pe only � ,yan���l e down � � .
7'r�? roots in �n�� L-ank and �umt� t�nk. S�conr� tank sh�uld
h�ve �nanhc�I� riser. �u� r,n ,�ncl ���al�ght uA to grade.
f_�ne�r� qnod� baffelq on , t�a w�re� leaks at thi.,, ti�t�e.
3.st r.�nlc - �" , 2nc] tank 6 ' � p��riiE� tan.k r"
NOTE. This is or�ly a#��rk r�pp� Thfs �s nat a compliance inspectian for o'
nor does it r��face a complisn�e inspQctic�n. � �nt of s�le
License # ��g
� �� ���d L�GLcL6�9L o� �osx�s�a r x�z� v,r� C.0=0T �o0z'TO'?�o
�ct.01.2009 1�: 06 AM ELI�R J PETERSON C�
7�3972721; PAGE. 1/ ?
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a��\ , Y��� L(o�a*o�u wNr�s�p•��•ia�+uuwu p�+,�P�ran�+u swrrr��� � £
'i( Lounv�,�,q.w w p•+waa�,c;�.,�,.x,�a+e�u„p�;.�,�,�,�, � �
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�~~—..�— � � w"""°�'w�*m,��1����s .
'�`►w� C�
.l�s�a.�l�++Q ap�qne a.�qcud � �''�le'"s a��t�w+rrd'r ap��,,.M,r++�'„�w
?Ml�i f�1�4u�C!)�tid�w p�� '�1�i
�P�u0pat��po,p�� ��►�IfM+�PI'��y(�
!��!i�Mp�� ❑ �At �►h�j �liiA+�►aN��I�1(�h�c�/7�Npi1�`
�4�1 M�qO�+� Q
���#1r�dyy� Wi t�,�� '«�Id�d1�s ja���� �
tlit{+o�(}):*����
r�):.�,.�,oy,N„�a,p�,b�
------�-�
� �lT� '����t�� vr�"�uo��►'�MLL
-� � � ����
* �'�+��'��
'.�"��r�„�,�,q„���,��
�+�� ����4 wu.w'�r a,e� �
L� ��nt+�ra u+ol��ig
�+unu�d
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� �i�.:;l ii ��:.,. _ �
-------_ S�,sr ��.��a us. �� Corn�lian? U Noncompliani:
—------------
jas deternlined by fhis form)
�fAE� ��,3�=1�'r."���a�.' r ;"�9r�.`���, �a '.���2��" �3�9'�'�„�����V'ls,=.
a., .Y,: -�.3i.��v� 9r� ✓'�P ..
Date oi obseniation: lt6J `/Qp p Reason for observation: _
This informatian on this form d s not expire.
�Q���piiG;7ce�ues�iCr;s/c;'iTe�'ia: (Required) 'J�;';,i��'iion iVfei'itpG"*: (Opfional)
Check the a ro riafe box
— �Che k the appropriate box)
For systems built prior to April 1, 1998,and not
locaied in Sho��land or i�lellhead Protection Conducted soil observation(s)( �
Area or not serving a food, beverage or �T�previous verifications(atta�s�ir��
lodging establishment: I
❑ Other: �f'eQ0 Ou�°O�t�—
Does the system have ai least a tvvo-ioot I « J �
vertical separatior distance from penodically �__ T�___
saturated soil or bedrock? ❑Yes i�lo •
For non-per�ormance systems built April 1, �J� ���,�
1996, or later or ior non-perfonnance systems I `��J—�"�" � _.��--3-��—
located in Shorefand or t/�lellhead Protec5on Soil observaiion does not expire. Previous observations
Jareas or sen�ing a food, beverage or lodging b;�tvvo independen,parties are su;iicient, unless site
establishment: conditions have been altered.
Does the systern have a three-fooi vertical
separation distance from periodically saturated ;
soil or bedrock?' __� (�Yes ❑ No
For reduced separation distance sysiems(i.e., I
"perrormance"systems under old 7080.0179 or I " May he ieduced hy up to 15 percent if alloaved in local
Type I\/or V system under ne�,v 7080. 2350 or ordinznce.
7080.�400):
`"'IVo standard nrotocol exists. This list rs noi e%haustive,
Does th�srstem�ne•�t the designed ve��tical in seciuentral order. nor does it indicafe vvhich
separation distance from periodically satzrrated comhinations are necessary to make this
soil or bedrock7` I ❑Yes ❑ No determin_ation.
�,ny"„�"a€�swer irr�'icazes�'hat P1�e s_�sie;»i�failir,�z io n�:�ie�t
�.,,0`rliC� _�,.�,.
a..'� .. . __ �.�.:i
This form is to be coinple�ed and attached to the Summary Fonr ofthe NlinnesoYa Pollution Control Agency's(MPCA)Cerr�7ii�_;�c�
ia g :o ::tO.' _ � 'i !C : JS:d:14 L�'�::3:'U :aC�:�a�i^,`;? :
completed b, an inspector or designer. Comple�ed fonn must 6e suamitted ObsQrv�cal�nitnof govern'meniavi�thin 15`aay5s must be
Properiy owner name(s):
Property address: �/�� �.."^jLC�c _����� --
_ ----— ---
Propeity ov�✓ner's address(if different):
Count��: �.�v Phone:
I here6y certify that l personally made the obse�vations, interpretafions, and conclusions reported on this fonn and fhai they are
correct.
Name: �o ,������� Certification number: �J,4
Business license name and nu�nber: �L�j,,q !v dS r' r�,
-��- - ---- �'zJ _- - °'�
Name of loca� �mit of government: �,� �(j�
Signatw-e: Date: �
- �__,�_ �•_o�____-
wq-��,visis4-3i Con�tiar-,ce(i�lspec�ier,}-orrnjor Ex,tstii�; SSlS
9li108
Parcel number S�sterr�stetu�. �
------- -- -- 1 L, Com liant
--- p Noncompliant
(as determined by this form)
�=�a�'r�xa�;: � ' , b ._ . � .��;.rt����� �3►,��' ' �._
lJs .f.'iIF
a.JS��77C�);-�..L ?J.?'•si� tp6:` ;J•''
,3;�nl icabilit��:
is the system operated under an Operating Pennit? ❑Yes �lo i;"»� " � � ,;. -,.
s , .;�vn comaltie i�,.� , .�, -aelo�v
Is the system rec�uired io employ a nftrogen BMP? ❑Yes No Ii"yes", chen corr;�lete iti�m 13, aeloµi
h`the ar,�tive��ta.Uoth�ues[`ions is "t,o'; :n�-;� �his fo�r.�t does notn�ecl Po be com.ole��d.
C�t;�1;�`e;_;Cet313:'il-e',i3/C;'ii�et'i�: (Required)
(Check the appropriate box)
A. For systems�vith operating perrnits:
Has all the required monitoring and maintenance taken place and does the monitoring indicate compliance�n�ith the
�ermit thresholds?
❑Yes ❑ i�!o
B. For a system fhat has a required nitrogen reducing BMP and does not have an operating perinit:
Is ihe nitrogen B��AP in-place and appears to be properly opera"ting? ❑Yes ❑ No
�=,�._r ,;r�' _..., ,�:,��.it,.;ca�v_ ,.v.,��rr;>l,"�<�r.�
Da�e of observation: _ P,eason fvr obsen.�ation:
Operating permit number:
1 his form e�:pires uj�on ne;:;i;�sj�ec't;cn ,�r;n��re� ;�ears. �r�hichever occurs first:
This form is to be completed and attached to ihe Surrnnary Form ofthe Minnesota Pollution Control tigency's(f�APCA)vem�?si�n,e
�<<§���'?'=" �-� :;�, _;,i�ti„r;,t't�s�,, ,c,;,�� �,,�� �,,;,o� �„�tA;-,�,, ��servaiions, interpreiaiions and conclusions must be
completed b;an advanced mspecto� seriice p-ovider or maintainer(maintainer for holding tanks only). Gompleted form must be
submitced to the iocal unit of government within 15 days.
Property o�Nner name(s):
Propert;raddress: ��„__��� �
Propertyo u�vner's address(i�different): '
County: �w� Phone: ---- —
�
/hereby certify that/persona/!y rnade the observations, interpretations and conclusions reported on this form and fhai fhey are
correct
Name: �p,(,,c,� � �,�E,,v Certifica on number: ��k�
Business license name and number: /�f,e.� `LCS / SG krJ �e�t�-,.• � ���
or
i'�1ame of local unit of government: (�,Q p
Signature:
�-� Date: �O � p g
1�--
wq-wwis ts4-31
��>>pg Compfiance lnspection Form 1`or E,�istin�SS/S
� o�
O O CI'TY OF ORONO
5.
�i-.
� � � �- � Municipal Offices
'� � Street Address Mailing Address:
�� �4 G 2750 Iielley Parkway P.O. Box 66
'� �i Orono, MN 55356 Crystal Bay, MN 55323-0066
�kESH04
To: The Current Owner of Address 2195 FRENCH LAKE RD
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 n-Compliant
Yes
No
If yes, system must be brought into c pliance by:
December 31, 2007
December 31, 2010
Other
Septic Tank(s) Pump�eut Needed
Yes �J
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 �S - � -03
The tank(s) should be cleaned through the manhole and not through the inspection pipes, this
allows for proper cleaning.
Comments:
� �
. ����
Inspector. Date of Inspection: � � d�
Telephone (952) 249-4600 • Fax (952� 249-4616
www.ci.orono.mn.us
Septic System Upgrade Deadline is Approaching
Here's a friendly reminder to all Orono property owners with non-compliant onsite septic
systems. Beginning in the mid-1990s the City began to identify those septic systems that
made use of trench drainfields, a majority of which do not maintain the minimum
required vertical separation above seasonal water tables. Each existing system was
subjected to soil borin�s to determine the seasonal water table depth. When a system was
identified as non-compliant, the owner was notified of the need to bring the system into
compliance and given several years to complete the upgrade.
The deadlines to upgrade were divided into whether or not the property was in the
Shoreland District (within 1000' of a lake, or within 300' of a protected tributary stream).
Properties in the Shoreland District were given until December 31, 2007 to become
compliant. Properties outside the Shoreland area with non-compliant systems were
allowed until December 31, 2010 to conform to the septic code.
Don't wait until the last minute! The City is strongly recommending that property
owners not wait until the deadline arrives to brin; their systems into compliance. The
process to upgrade your septic system can be quite lengthy. The first step in the process
is to hire a site evaluator & designer to determine what type of system is required and
provide the blueprint for the system installation. The property owner must then contract
v��it�a septic syster.� irsta?ler to have the system constructed.
The installation of septic systems is very weather dependent, especially for mound
systems, which can onTy be installed when the �round is relatively dry, i.e. typically June
thru September. Contractors' schedules fill up quickly, so it's important to start your
planninb and design process now to ensure a timely installation. The period of time from
deciding to update your septic system to the actual installation can easily eaceed three to
four months or more. Please contact the Buildinb and Zoning Department at (952-249-
4500) �a�itlZ ai�v 1L1PSt101"!S v011 mcly 11c7Ve a�10Ut bT1T7�lri� VOUP SeUt1C SVSte121 lrit0
compliance.
F'or a last of licensed designers aa�d instal�e�s you flnay go to ������.�fl.�r�a��.�r�.�a�,
e➢ic� on City I)epartments, click on Se�tic, then clicfl: on �he link to
w����i.t�c1.state.mn.us/pro�rams.
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;qr,,3. ,�,,�- , � C ITY of ORONO
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�, ��, �� , " H, Municipal Offices
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�� ,., Street Address: q 5a-a4 q'y bo � Mailing Address:
,l9 EB�� �,�i�
� p �;� 2750 Kelley Parkway P.O. Box 66
��--� Orono, MN 55356 Crystal Bay, MN 55323-0066
To Current Owner: Address: � � �S �����'ti j-�9 l�� � G�
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 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 construction standards of the current Orono
Municipal Code but does meet the tluee foot separation requirement or rivo foot requirement for systems 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 designated 100-year flood plain,any ISTS which may
or may not meet all the location,design,or conshuction 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): S
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Septic tanks must be pumped out this year (city code recommends tanlcs to be pumped out once every 3 years.
Tank was last pumped ).
Make sure septic tanks are pumped throu�h manhole and not throu�h white inspection pipes. This allows for the proper
cleaning. Keep water softner and iron filter discharge out of septic svstem to prolon�life of drainfield. Ask pumper to test
alarm float to verifv alarm is still working in�our house. The alarm warns owner that septa�e is about to backup into basement.
7 Inspection risers missin�-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.
COMMENTS: � `I S-E�rv� �1 C <r~���.�.�ro� /lc�� - Co►M �1 ��1aT
A,� � r�� s �-- �Q v��+�-�-e� � u �,�� 3� — ao�--�
�
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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 e�cisting system will continue to function properly, but is merely an opinion of the adequacy of the system under current
�/ O \�
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I,, 4;a; r ;,;:a_ , ,� j CITY of ORUNU
�, � ,, ;r� I,
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' ,,, }' Street Address: Mailing Address:
._.�� ,¢�i,, ;
����EBII�;:=�� 2750 Kelley Parkway P.O. Box 66
�—_' Orono, MN 55356 Crystal Bay, MN 55323-0066
To Current Owner: Address: ��9� ��'���� �-{'��-e �(��
City Oi•dinance 199 requires that each existing on-site sewage trearinent 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 (1-3): 3
1 "CODE SYSTEM" An ISTS which meeu all the location,design and construction standards of d�e cttrren[Orono Municipal Code.
2 "COMPLIANT SYSTEM" An ISTS which does not meet all the location,design and construction standards of the current Orono Municipal
Code but does meet[he three foot separation requirement or two foot requirement for systems installed 1996 or eazlier,and which is not failing or
�` an imminent threat to public healUi or safety.
l .� J"NON-COMPLIANT SYSTEM" A prollibited ISTS;an ISTS located wititin 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[STS with less than diree feet of unsaturated soil or sand between the distribution device and the limiting soil characteristics.
TANK CONDITION(5-7): 5
Tank inspection indicates:
� Pumpout not needed at this time.
6 Septic tanks must be pumped out this year (city code rec�uires tanks to be pumped out once every 3 years.
Tank was last pumped ).
Make sure septic tanks are pumped throuEh manhole and not throu�h white insnection pipes. This allows for the
proper cleanin�. Keep water softner and iron filter discharge out of septic svstem.
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): �
�Drainfield is dry, no surfacing evident.
Some evidence of surfacing, not critical yet.
10 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately. Repairs must be completed within 90 days.
COMMENTS: ��.,�-.��:i� '� � s����- �.��-_�\;�,^�- �}t,cl ,�-.��,,-- �� �z�lh�ti�l
�--�i ���1� - 2c:��� o � t c�_�z��r� � �:�-r S t•,.zr
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55 ,�1—(,'� U�„-�
Date of Inspection Matt Bolterman - Septic System Inspector
Note: [n the event that this inspection report is used to satisfy the requirements for a mor[gage or other Vansfer of property,be advised tltat this report does not guarantee
or certify that an existing system will continue to function properly,but is merely an op inion of the adequacy of the system under current conditions based on the available
information.
Telephone(952) 249-4600 • Fax(952)249-461b
www.ci.orono.mn.us
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� �;�����, :� ,� CITY of ORONU
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.� '�'�,��t7�°��i"��.� Street Address: Mailing Address:
`��gg04' 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
9sa-�49-y600
To Current Owner: Address: � ��� 5 `r z`` `�` �`�k� r<<�I
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 (1-31: 3
1 '�CODE SYSTEM�� An ISTS which meets all the loca[ion,design and construction standards of the current Orono Municipal Code.
2 "COMPLIANT SYST'EM'� An ISTS which does not meet all the location,design and consvuction standards of the current Orono Municipal
Code but does meet the three foot sepazation requirement or rivo foot requirement for systems installed 1996 or eaztier,and which is not failing or
� an imminent threat to public health or safery.
( 3 ) "NON-COMPLIANT SYS'TEM" 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 conswction standards of the current Orono Municipal Code and which is failing for any reason;and
any[STS with less than three feet of unsaturated soil or sand between the disvibution device and the limiting soi]chazacteristics.
TANK CONDITION(5-.7�: �
Tank inspection indicates:
SO 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 7- I�-� � ).
Make sure septic tanks are pumped throu�h manhole and not through white inspection pipes.
This allows for the proper cleaning.
7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank.
DRAINFIELD CONDITION(B-�QL' ��
� 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: ��Is3c� �� nc�.- C�,��i.-.� d�� �-u Conp\...�,�� ��5�;�-r .�,.� —
51�� .�•����� � t'�F1- �i— Sf�+iC;.��}—�.. r.� �:}wits� �cno� ti �f..� � t-;cl�� G�L� 'Lf
�(� 5��4�5�,_ .� .,.r�,�t•- r�,��� _ ILc���,<< b i ��_`3�- �o r�7-
1 0 -�-`"�- � \ `"1 '\�,�C ���2��`
Date of Inspection Matt Bolterman - Septic System Inspector
Note: In the event that this inspection report is used to satisfy ihe requirements for a mortpage or other transfer of property,be advised that this report does not guarantee
or certify that an eristing system will continue to function properly,but is merely an opinion of the adequacy of the system undet current conditions based on the availabie
information.
-
� Compliance Inspection �orm for Existing
�.�
Individual Sewage Treatment Systems
v-
This form reflects the requirements of the 1996 version of MN Rules Chapter 7080
Minnesota Pollution Control Agency
Note:Local inspection standards may be more or less restrictive than the state requirements. These differences must be made available by the Local
Unit of Government.
Date of Inspection:
Property Owner(s) - Telephone( )
Person requesting inspection(if different than owner) Telephone( )
Reason for inspection: •. %
Site Address ��.�, �� �. � . City � f�. �;
Zip Code Unit of Government Regulating this property ; ' ~ �./
Fire No. Parcel No. Township Name T
Township Range Section Quarter
(Check appropriate sewer system component and indicate location on site sketch).
Tank s : Soil Treatment s,sy tem: Other(briefly deseribe): Flow Meter
�_- Septic tank . Rock trench _Altemative system
Aerobic tank y Gravelless pipe trench _Experimental system Yes , No
Pump tank Chamber trench Warrantied system If yes,
L Holding tank Seepage bed Exp.Date:
Other Mound Other
_At-grade
�stem Classification
System Built Prior to April 1, 1996 and not Located in Any System located in Shoreland or Wellhead
Shoreland or Wellhead Protection Area or Serving a Protection Area or Serving a Food, Beverage ar
Food, Beverage or Lodging Establishment Lodging Establishment, plus all systems Built after
April 1, 1996
Is the system an imminent public health threat(IPHT)?Upgrade Is the system an IPAT? U�grade
1.Discharge of sewage to the ground surface? YES NO 10 mo 1.Discharge of sewage to the ground surface? YES NO 10 mo
2.Discharge of sewage to draintile 2.Discharge of sewage to draintile or
or surface waters? YES NO 10 mo surface waters? YES I�O 10 mo
3.Sewage backup into dwelling? YES NO 10 mo 3.Sewage backup into dwelling? YES 'NO 10 mo
4. Situation with the potential to immediately and 4.Situation with the potential immediately and
adversely impact or threaten public health or adverseiy impact or threaten public health or
safety? YES NO 10 mo safety? YES {'f�IO 10 mo
Is the svstem failing? Is the system failing? " '
5.Less than TWO feet of vertical separation between 5.Less than THREE feet of vertical separation betweg��.
system bottom and saturated soil or bedrock? YES NO LGU** system bottom and saturated soil or bedrock? �YES „J�3£3 �,GU**
6.A seepage pit,cesspool,drywell,or leaching pit? YES NO LGU** 6.A seepage pit, cesspool,drywell,or leaching pit?YE3 NO LGU**
** LGU=Local Unit of Government ordinance must specify the time period within which the system must be upgraded.
STATUS OF THE SYSTEM
Based on the compliance criteria above the system status is (check ope)C] in compliance(functioning)[]failing O an imminent threat
therefore,this document is a(check one)�Certificate of Compliance .�)Notice of Noncompliance.
E
Page 1 of 2
v- . , n,� y_ .,.n.7:� ""`e'F ...:.,.,�
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What methods were used to make the determinations fox the compliance inspection?_�f-�.�— � ' �� "j
�_ �, �.Yr�. �e , � � -.
Please attach the followinE:
1) Site sketch. Suggested items for drawing include:Well,well setback to system,dwelling or other establishment,tank(s),soil treatment system,
reserved soil treatment area,curtain drain,property lines,waterways,and buried lines(those NOT installed by the utility). Include sizes and
length and approximate distances from fixed reference points such as streets and buildings.
2) Soil boring logs,showing each horizon. Indicate the texture,structure,color,depth of each different soil type,evidence of mottling,bedrock
and standing water and whether the material is fill. Locate each boring on attached site sketch.
3) A list of any and all requirements of the local ordinance that aze different than the sate requirements referred to on this form.
CERTIFICATION
A. I hereby certify that all the information I have provided regarding the individuai sewage treatment system is true,accurate,and complete.
Property Owner Date
B. I hereby certify as a state of Minnesota licensed Inspector and/or Designer I or Qualified Employee Inspector and/or Qualified Employee
Designer I that I conducted an investigation in accordance with applicable requirements that accurately determined the compliance status of this
system and that my observations recorded are accurate as of this date. No determination of future hydraulic performance has been nor can be
made due to unknown conditions during system construction,abuse of the system,inadequate maintenance,or future water usage.
Inspector's name(print) �`�;� 2:� � r:� f ���'�L C .�I Phone `�'�,��`�'.�= r': .. �'�
License and/or Registration Number .,_.���� Address �',/'`���=�� ,<° _,;�,f�� �' ,-. .�_� ,�"�.i�- " �!;��..;,',kl.l.�
Employed by.. /� ,wt"1,•i J.; :_1 ..{.�"e}?�+�:. Address .�=� ,1 7�'
— �- �
Valid until ,unless the system becomes an imminent threat to public health or safety as defined at Minn. R. 7080.0020,subp. 19a,before
that time. �'�',
Signature �,�,��_ � �=-�f���"�-R--�"-�:-�-''' Datc ',`- ,�
U�arade Criteria
Minnesota Statutes § 115.55 ("law") Upgrade Requirements
Any situafion witt�the potential fo i,-nmediate/y ar,d adversely affect or throaten public health or safety, must be upgraded, replaced, or
its use discontinued within ten months of receipf of this notice or within a shorter period of fime if required by local ordinance.
lf the local unif of govemment wifh jurisdiction over the system has adopted an ordinance containing altemative local standards, the
existing system must comply with the ordinance. If fhe system does not comp/y with the ordinance, it must be upgraded, replaced, or
its use disconfinued according fo the ordinance.
If a seepage pit, drywell, cesspoo/, or leaching pit exists and the local unit of govemment with jurrsdiction over the sysfem has not
adopted local standards to the contrary, the system is failing and must be upgraded, replaced, or its use discontinued within the time
required by local ordinance.
If the system fails to provide su�cient groundwater protection, then the loca/unit of govemment or its agent shall order that the system
be upgraded, rep/aced, or its use discontinued within the time required by ru/e or the local ordinance.
!f an existing system is nof failing as de�ned in law, and has at/east hvo feet of design soi!separation, then the system need not be
upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This does not apply to
systems in shoreland areas, wellhead protection areas, or those used in connection with food, beverage, and lodging establishments
as defined in law.
p:\ists\prog_dev\exinp9.doc-6/99 Page 2 of 2
r �
Site Sketch: '� "
._ .. . .. . .. . ,� _,. -. .. .. . . .. . . . , .. . ..
.. .. .. .. ' . ..... . ,}. ... .. . .�:.. .. . . .. . ._ . . . ' .. .
, .. . .. .. . ...�..r. . ' . {, . .. . . -•� .. .� �
. .. . . .. . .. . ...� . . j�. . .. . .. . .. � . .- •
.. . .. . .. . .. . ...� . ..�,. . .. . .. . .. . _ .. .... , ..
-. . .. .. . . . . .. ,�.. . . � . . .. ' .. . ..
. .. . . . .� . .. . ...� . . . .. . .. . . , . . .. . ..,..
. .. . .. . .. . .. . �. .— .. . .. . .. . .. . ...�... .. .
� . .. ,�. � yt . . y. . . . `1;�,,{.j� . . . . .. � . . . .. I:
F- , ...� .. . ..� �� �1.. ,�"``•,,`+*� .. .. , .. . IOU' �
....... . . . ' ' ' .;, � ,,, .. -. � 10' 20' � 7
..:.. . .. ...... �� ,. .. .. ... � . .. . . N
. ; . .. . ..�,/'. -� - -- , � .. We�� ..
.. . .. .. . .. . . .. p l0U'
rf
Plense indicate thc location of: Wcll,�s�.11 setback tu s}'slrm,dwelling or nthe.r est�blishmcnt,tank(sj.soil trtx�icnt sysfem,
rese�ved.pil Iretllmcnt arca,cmtain drain,properly lincs,�vntcnva}'s,and buried linrs (thosc NOT itlstalled by thc utilitv).
Include sizes<utcl lengch and approximate distances frqtn fi�ed refcrcnee points such s,s strcrts and buildings, please attach as•
built dra�cin�s,inspectiotl repi�rls,Ccrtificat(sj of�omptianca t�nd Noticc(sj ofNoncompli�mre,if alvailable.
Soil Burings (BR#): Loeatc eaeh boring oa.z tlae map above, indicate on the ribht o�the c��luinn the soil
texture, struct��re, color, deptka of eac�i differ�nt soil type, evid�nce of mott]ing, bedxock and stv�din� �•atcr.
Also i�adicate if the ttiaterial is lill.
BR 7 l3R# BR# BR# BR# BR#
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W:CbRn DEPTH c�F i-fUTTLIIvG,SEASUNAL IIIC[; W'A"T�R OR BEDROCKQh AIlOVE Ll�tl�$
Cnmment�: _ . .
��'hat nceds to be coml�leted ti�bring the ahi,ve system into compli.ince if found not in compliance7 - '- �-
�� r'� � � �r::'t'6)�' � � � � �
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���;��� C ITY of ORONO
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�`�'� �.�`��'yG Street Address: Mail(n� Addreu:
EggO¢ 2150 Kelley Pa�kway P.O. Bax 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: /�'������r ;fi� ���c' c' ; S Address: ���5 �"�e��� ��i<�- �d
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 agpears to fall into the categories checked below.
YSTEM CONFORMIT'Y 1-3 : �
1 ��CODE SYSTEM�� An ISTS which meeLs ail the location,desigp and cons4ruction standards ofthe cu:rent Orono Municipal Code.
2 ��COMPLIANT SYSTEM° An ISTS which does not meet all the locatioq design and cons4vction standardv ofthe curirnt Orono Municipal
Code but does meet the three foot separation requirement,and which is not failing or an imminent threat to public health or safety.
3 "NON-CONIPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-year flood plain,any ISTS which may
or may not meet all the locatioq design,or construction standards of the currerrt 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.
T:�NK CONDITION(5-10): S
T:ink inspection indicates:
� Pumpout not needed at this time.
fi Tank must be pumped out this yeaz (city code requires tanks to be pumped out every 3 yeazs. Tank was last pumped ����� �� ),
7 Solids accumulation in tanks is at a critical a critical level. Tanks should be pumped out as sooa 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 couid 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 years,they should be pumped out now.
10 Inspection pipe is located directly over tank 6affle(does not give accurate measurement of solids accumulation). If tanks have not been pumped
out within tha last three yeazs,they should be pumped out now.
D LD CONDITION(11-14): 1�
Drainfield is dry,no surfacing evident
12 Some evidence of surfacing,not mtical yet _
13 Drainfield is saturated and visibly discharging urrtreated efflurnt to the surface. Cotrtact the City Iaspector immediately.Repaus must be
completed within 90 days.
14 Draintizld ea�tent and condilion unknown
CONIlVIENTS: sys-j-c� \ad�s o `� _ �v-s— ��Spc�r ;�� � �c� ��ic�C 0�
C�a��^'�S�Dpc� �`^OS� �"C c�C���� �'D C� SS`��\0�-- � °�C�
S v f `ti��Ci
Sc/ p� ��r:�'1 'n'��c,��5
� �� � � �a� �
Date of Ins ction 4
� Septic System Inspector
Note: In the evrnt that this irupection report is tued to satisPy tho requiremevts for a mottgage or other h�ansfer of property,be advised that this repo�
or cer[ify that an esisting system will cor�Iinue to function properly,but is merely an opinion of the adequacy of the system under cuirerrt conditions�
info�matioa
CITY OF ORONO � O�
Municipal Offices O O
Post Office Box 66
Crystal Bay, MN 55323-0066 � � ON–SITE SEWAGE TREATNIENT
r,�, � INSPECTION REPORT
ti
���kESH04�G
Owner://l!�/�J�IU�7 �� /1��t-� Address: ��`�5 f—r�L?c 6� L<c /�� �553�I/,
Permit �'s: � Dates: ��f lW�`'�� Contractors:__ �«�� �G�`1!'lSvY��
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 uhich meets all the tocation, design, and construction standards of the current City
Codes, and which is operating satisfactorily by treating and disposing of the entire current sewage input
without discharging any pollutants into ground or surface waters.
2 "CONFORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the
current City Codes, but Was installed according to the code in effect at the time of installation, and which
is operating satisfactorily by treating and disposing of the entire current seuage 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 any system uith less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soit characteristics.
(The limiting soil characteristic f� has or [ ] has not been identified at this time. If the limiting soil
characteristic has not been identifPed, this classification may be subject to revision.)
TANK CONDITION (5-10):
inspection indicates:
5 Punpout 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 uithin 48 hours to eliminate surface discharge.
9 Inspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
tank at next purt�out. If tanks have not been pur�ped out uithin 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 acaxnulation).
If tanks have not been punped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14):
�hfietd inspection indicates:
11 Drainfield is dry, no surfacing evident.
Sane 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.
14 Drainfield extent and condition unknoun.
LIMITING S1TE FACTORS (slope,setbacks,etc.): --�—"-
POTENTIAL FOR SYSTEM FAILURE (depends on soils,water table,etc.): Q/,�,�
COMMENTS: l
__ �
Date of I spection 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 uill continue to function
properlyi 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=tion and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
�o�
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��� �� CITY of ORONO
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�C'EggO 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: ���y��0 v� �! n 1��PV � Addres s: 2195 French Lake Rd.
Permit #'s: 7715 Dates: 11/14/84 Contractors: Jerry Johnson
(This is [� an existing system [ ] new construction) .
SYSTENI COMPLIANCE (1-3) : 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.
3 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 been identified at this time. If the
saturated soil leval has not bean identified, this classification is subjact to revision.)
TANK CONDITION (5-9) : 5
Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year.
7 System is discharging to the surface. Tanks must be pumped out within 48 hours.
8 Inspection risers missing-tanks could not be inspected. If tanks have not been pumped out
within three years, they should be pumped out and risers installed now.
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 tha last saptic tank Maintenance Pumpout the tanks [ ] were or [ ] wara not confirmed
to be watartight by the licensed pumping contractor. If the tanks were not confirmed to be
watartight, this classification is subject to revision.)
DRAINFIELD CONDITION (11-14) : 11
11 Drainfield is dry, no surfacing evident.
12 Some evidence of surfacing, not critical yet. Repair is not required at this time.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface.
Contact the City Inspector immediately. Repair must be completed within 90 days.
14 Drainfield extent and condition unknown.
POTENTIAL FOR SYSTEM FAILURE: (system age and condition, soils, etc.) : low
COMMENTS:
��.,�� /7�7 _
Date of Inspection Se c 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.
'a'elephone (612) 473-7357 • FAX 473-0510
CITY OF ORONO � O�
Municipal Offices O � O
Post Office Box 66
Crystal eay, MN 55323-0066 a � ON–SITE SEWAGE TREATMENT
r� � INSPECTION REPORT
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Owner:�i�'��)'\, ,,/� �/f� Address: �/ � �i�/Y� /irA� KQ•
Permit #'s: Dates: �!�/�'T—l�� Contractors: , )`O,T �QY�
✓
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 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 seuage input
uithout discharging any pollutants into ground or surface uaters.
2 "CONFORMING SYSTEM"-A system which 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 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 alt the location, design, and construction standards of the current City
Codes and which is failing for any reason; and any system with less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soil characteristics.
(The limiting soil characteristic t�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): �
T� inspection indicates:
(5� Pumpout not needed at this time.
'S 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. Inspection risers (4" dia. pipe) must be installed in each
tank at next purtipout. If tanks have not been pumped out within the last three years, they should be pun�ed
out now.
10 lnspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
!f tanks have not been punped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14):
Dr,e�field inspection indicates:
(_1Y Drainfield is dry, no surfacing evident.
f2 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 uithin 90 days.
14 Drainfield extent and condition unknown.
L1MITING S1TE FACTORS (slope,setbacks,etc.):
POTENTIAL fOR SYSTEM FAILURE (depends on soils,water table,etc.): ��X��
COMMENTS:
Date o Inspection S tic 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 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 Box 66
Crystal Bay, MN 55323-0066 � � ON—SITE SEWAGE TREATMENT
� � INSPECTION REPORT
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Owner: !_�►/!t'��7(��` ��Y1N�►r Address: ���� �1�i�I'�G� L.�K� K�.
Permit #'s: %��� Dates: �/—�y-�0�� Contractors: ;l�r►-v "1`y/�r`�l'�
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 f� an existing system [ ] neu 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 which does not meet all the location, design, and construction standards of the
current City Codes, but was installed according to the code in effect at the time of installation, and which
is operating satisfactorily by treating and disposing of the entire current sewage input without discharging
any pollutants tnto ground or surface waters.
3 "NON-CONFORMING SYS7EM"-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 with less than 3 feet of unsaturated soil or sand
betueen the distribution device and the limiting soil characteristics.
(7he limiting soil characteristic '[y� 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): �
T�qk inspection indicates:
�9' 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 5olids accumulation in tanks is at a critical level. Tanks should be pumped out as soon as possible.
8 System is discharging to the surface. Tanks must be pumped out uithin 48 hours to eliminate surface discharge.
9 Inspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
tank at next pumpout. If tanks have not been purtped 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 pumped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14):
Dr field inspection indicates:
�1 Drainfield is dry, no surfacing evident.
'f2 Some evidence of surfacing, not cr�tical 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.
14 Drainfield extent and condition unknown.
LIMITING SITE FACTORS (slope,setbacks,etc.):
POTENTIAL FOR SYSTEM FAILURE (depends on soils,Water table,etc.): �,�
COMMENTS:
�
Date of Inspection S ptic ystem 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 locetien and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner