HomeMy WebLinkAboutseptic info � �� .
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,� �,�:r���? � �ITY of t)RO1�T0 �
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'�.�,�;.���.¢'� Street Addreu: MaNn�Addreu:
. 2750 Kelley Parkway P.O. Box 66
� Orono, MN 55356� � Crystal Bay, MN 55323•006�
� • 95d-�4q-4600 �
To Current Owner: Address: a� L'��� ' �"��.- �`��j e
City Ordinance 199 requires that each existin�oa-site sewage treatrnent system in Orono be Inspected every two years.
The on-sita sewage treatmeat system at the above address has been Inspected and appears to fall into the categories checked below.
SYSTEM CONFORI�IITY (1-3): �,
1 "CODE SYST'EM"M ISTS whieh meets all the locadon,dulgn and construcdon ssandards of the current Orono MunicipaI Code.
2. "COI�LIANT SYSTEM" An iSTS which does nat meet a11 the locatton,daign and eonstruction standards of the eurrent Oruno biunicipa!
Cade but doa meet the ttuee foot separatlon nquinmertt or two foot aquinmrnt[oc sysums installed 1496 or earlier.and whlch is not faYling or
an tmminent ttueat to yublic health or safery.
3�'NON-CONiPLIANT SYSTEM" A prohibited ISTS;an ISTS lacated withIn a duionated 100-year flood plain,any ISTS which may
o�may not mect all the location.duign�or eoosWction standards of the eurrent Orono Municipal Code and whlch Lt failing Wr any reason;and
any ISTS wich less than three feet of unsamrated soil o�sand between the distribution device and the limiting soil eharacucistics,
TANK CONDITION(�-:71: s .
- . . � .,.
S(�•inspection indicates: � . . , .
mpout not needed at this time. .
6 Sepuc tanks must be pumped out this yeaz (city code requires tanks to be pumped out once every 3 yean.
Tank was last pumpzd_ ?-1—D t �, •
�iake sure seatic tanl:s are oumoed throueh manhole and not through white tnsnectIon nipes
This allo�ss foc the orooer cleaninQ.
7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tar.k.
INFIELD CONDITIO�I -/Q : �
8 Dninfield is dry,no surfacing evident.
Some evidznce of surfacing,not critical yeG � •
10 Drainfield is satunted and visibly discharging un�eated effluent to the surface. Contact the Ciry Inspector
immediately.Repa'us must be completed within 90 days.
C01�N?S: b c�;c�,�\� :� �c�- co�.Q i:�.�- ��J n:v 5-3- b� ;c�1n«</
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1 � 'Z-�--dZ-- � _
Da:e of Inspecdon I�fatt Boiterman- Sepdc System Inspector
hote:tn the event that this inspecdon teport is nsed W satisfy the rcquirtmeats Cor a mort,gage orothet transfa o[propetry.be advised that this teyact dca coc 8ua�.'+�-
or arsity that an existing system will continae to timcdon pcopedy,but is merety an opinion ofthe ac:equary o[the system tmder eumataortdidoasbased on the avail3b:
infocmatioa
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I;; Street Address: Mailing Address:
�9xEsx, 'Q�� � 2750 Kelley Parkway P.O. Boz 66
O
- _._..,:..--' " Orono, MN 55356 Crystal Bay, MN 55323•0066
To: The Current Owner of Address �.� (. :..� �C �r'�-'
City Ordinance requires that onsite sewage treatment systems in Orono be
inspected on a periodic basis. The onsite sewage treatment system at the above
address has been inspected and the following is known about the system. A
sketch of the known components of the system is available for most properties at
the Orono City Hall.
Imminent Public Health Threat
Yes �No
If yes, please contact the Onsite Systems Manager at 952-249-4626 within 10
days of receipt of this notice. The septic system must be brought into compliance
within 90 days. Failure to do so will result in referral to the City Attorney for
legal action.
System Identif as Non-Compliant
Yes
No
If yes, system must be brought into compliance by:
December 31,2007
December 31,2010 ✓�
Other '
Septic Tank(s1 Pump out Needed
Yes ��
No
The City recommends the septic tank(s) and/or lift tank be serviced and pumped
out every three years. City records indicate the tank(s) were last pumped out on
"7 - � r �v2 . The tank(s) should be cleaned through the manhole and
not through the inspection pipes,this allows for proper cleaning.
Comments:
*.
����� � �2b r a
Inspector: Date of Inspection q -
Telephone(952)249-4600 � Fax(95?)249-4616
www.ci.orono.mn.us
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��:;��-� ,� CITY of ORONO
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�A ��� �.;;.�;. ,y�' MuniCipai Ot�iCes
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� �, ;�r�;!e� � Stnet Addross: Maiiina Addrou:
�C',EgHO�' 2150 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MPI 55323•0066
Owner: �C l' ���.—{ M��f 5 Address:_a•S_ ���� � :�� R;�5�
�
Cin�Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every ttvo years.
The on-site se�vage treatment system at the above address has been inspected and appeazs to fall into the categories checked belo�v.
SYSTEM CONFORMITY (1-3): �J
I "CODE SYST'EM" An ISTS which mcets a11 the Locatioq desiga and constructioa standacdg of ihe cuaent Orano Municipal Code.
2 "COMPLIANT SYSTEM" An ISTS which does not meet al!the locatioq design and constcuction standards of the cuneut Orono Municipal
�� Code but does meet the three foot separation requiremrnt,and which is aot failing or an imminent threat to public health or safety.
�3 ) "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a daignated 100-year Aood plain,any ISTS which may
v or ma not meet all tha locatio desi
y n, gn,or construction standazdc of the cuae�rt Orono Municipal Code and which is failing for any reacon;and
any ISTS with tess than three faet of unsaturated soil or sand betwern the distribution device and the limiting soil characteristics,
T.4NK CONDITION(5-10): �_
Tank inspection indicates:
� Pumpout not nteded at this time.
� Tank must ba pumped out this yeaz (ciry code requires tanks to be pumped out every 3 years. Tank was last pumped y�-�6 �,
7 Solids accumulation in tanks is at a critical a critical level. Tanks should be pumped out at 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 risecs(4"dia.pipe)must bz installed in each tank at next pumpout If tanks
hava not bern pumpad out withi:t the last three years,they should be pumped out now.
10 Inspaction pipe is locatzd direcUy over tanlc baHle(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(11-1�): �\
11 Draintield is dry,no surfacing evidrnt
12 Soma evidence oFsurfacing,not aitical yet ,
13 Dra�eld is saturated and visibly discharging untreated e�lurnt to the surface. Contact the City Inspector immediately.Repaus must be
completed withirt 90 days. �
1� Drainfiatd estrnt and condition unknoan.
CONIN�NTS: S'f 5�-c-r-. :� �D�- �oMp t=�,�T d�� � 1q�k o� 3 �o�-- seAc��-:o�.
�o��-�c�� ba-��� a� �c'e�e.�.tS q� �-o . �.� )c�5o�� �. �-ab\c. e \tic� �
��--=�\ a-o\a . P�,..p ��� .
� - \�— o\ �r,�
Date of Inspection Sep6e System Inspector '
Note: In tha event that thig inspection repoR is usrd to satisfy the nquirementy for a modgage or other hansfa of propeRy,be advised that this repoR does not guarantee
or certify that an existing system will continue to function properly,but is merely an opinioa of the adequacy of the system unda cuarnt coaditions based on the available
infottnatioa
CITY OF ORONO � O�
Municipal Offices O O
Post Office eox 66
Crystal eay, MN 55323-0066 � � ON—SZTE SEWAGE TREATMENT
�`,, � INSPECTION REPORT
'�� G~
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9kESH0�'
owner�l9L'C`� �i=���L�� Address: o��� lif.�'i.,Ci �rnt ,�iClqQ �SS�.�Sq�
Permit �'s: �Jbl/ Dates:_ �U "�c�b'"�� Contractors: ��/��r S {'Y1L C t''r•
City ordi.nance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
The on-site seuage 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 (t-3):
1 "CODE SYSTEM"-A system which meets all the location, design, and construction standards of the current City
Codes, and which is operating satisfactorily by treating and disposing of the entire current sewage input
without discharging any pollutants into ground or surface uaters.
2 "CONFORMING SYSTEM"-A system uhich does not meet all the location, design, and construction standards of the
current City Codes, but 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 within a designated 100-year floodplain; any
system which may or may not meet all the location, design, and construction standards of the current City
Codes and uhich is failing for any reason; and any system uith less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soit characteristics.
(The limiting soil characteristic�� has or [ 7 has not been identified at this time. If the limiting soil
characteristic has not been ident��fi�,, this classification may be subject to revision.)
TANK CONDITION (5-10):
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Tanks should be pianped out as soon as possible.
System is discharging to the surface. Tanks must be pumped out uithin 48 hours to eliminate surface dischar�e.
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 p�xnped out within the last three years, they should be punped
out nou.
10 lnspection 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 C11-14): �
Dr field inspection indicates:
Drainfield is dry, no surfacing evident.
1 Some evidence of surfacing, not critical yet.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
irmiediately. Repairs must be completed uithin 90 days.
14 Drainfield extent and condition unknown.
LIMITiNG SITE FACTORS (slope,setbacks.etc.): l�i �.����� ,�
POTENTIAL FOR SYSTEM FAILURE Cdepends on soils,water table,etc.): �� �q��
COMMENTS: Cj�X�TI C S -W� r S LdYI�0�'!M �K � � �Q '/� C� �
E�p i2 � ;P �� � I 2-3/— ?c,c,
S r 2. e
�
D te of Inspection 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 uith the system loc�tien and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
� °� � .
0 0 �
'� CITY of ORONO
`�a���l\��. �+
`' � !� Municipal Oifices
�`•�';�.�`t.�� ti
f'✓il:�";.I
� ' 4,�',�y_ ��''�G Streat Addresa: Mailin�Addreu:
.� �,�'-;`ry�i i�-
'�l(y�Hpg' 2150 Kelley Pa�kway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
�
Owner: � Address: 25 Luce Line RidQs
Permit #'s: 1360 Dates: 10/a6/88 Contractors: Ray's ffiach.
(This is [ J 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 saturated soil level is (�] or is aot ( ] identified under this seDtic systsm. If the
saturated soil level is aot ictaa�itied, this classification is subjact to revisioa.)
TANK CONDITION (5-9) : 9
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year.
7 System is discharging to the surface. Tanks must be pumped out within 48 hours.
8 Inspection risers missing-tanks could not be inspected. If tanks have not been pumped out
within three years, they should be pumped out and risers installed now.
� Inspection pipe is located over tank baffle-can not measure solids accumulation. If tanks
have not been pumped out within three years, they should be pumped out now.
10 One or more tanks are cesspools, which means the septic system is non-compliant.
(Tha tanks are [ ) or are aot [ ] water tiQht or the coadition is �] unkaowu. If the tanks
ara aot confirsnad to be watartiQht, this claasificatioa is subject to revisioa.)
DRAINFIELD CONDITION (11-14) : 12
� Drainfield is dry, no surfacing evident.
r12� Some evidence of surfacing, not critical yet. Repair is not required at this time.
`"f 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.) : hiQh
COt�IENTS: 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 0.8 feet and the system is non-compliant. Repair or replacement of
the septic system is required by 12/31/2008.
`�a19� --
Date of Inspection e 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.
Tdephone (61Z) 473-7357 • FAX 473-0510
CITY OF ORONO �O�
Municipal Offices O O
Post Office Box 66
Crystal Bay, MN 55323-0066 a � ON—SITE SEWA(�R TREATMEI�I'1'
INSPECTION REPORT
ti
ti
'�' G
�9kEs8o�'�
Owner: �.�/��� �A ���� Address:
Permit #`'s:�3�1� " Dates:
/�—�7�� Contractors: �
City ordinance number 100 requires that each on-site sewage treatment .system in Orono be inspected on a regular besis.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the cetegory
checked below.
(This is� an existing system [ ] new construction)
YSTEM CONFORMITY 1-3 :
"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 "C�IPORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the
current City Codes, but was installed according to the code in effect at the time of installation, and which
is operating satisfactorily by treating and disposing of the entire current sewage input without discharging
any pollutants into ground or surface waters.
3 "NON-CONFORMING SYSTEM��-A prohibited system; a system located within a designated 100-year floodplain; any
system which mey or may not meet all the location, design, and construction standards of the current City
Codes and which is failing for any reason; and any,system with less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soil characteristics.
(The limitin� soil characteristic�has or [ ] has not been identified at this time. If the limiting soil
characteristic has not been ident i , this classification mey be subject to revision.)
TANK CONDITION (5-10):
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be punped out this year to help prevent future problems.
7 Solids accunulation in tanks is at a critical level. 'fanks should be punped out as soon as possible.
8 System is discharging to the surface. Tanks must be pur�ped out within 48 hours to eliminate surface dischar�e.
9 Inspection risers missing-tanks coutd not be inspected. Inspection risers (4" dia. pipe> must be installed �n each
tank at next purt�out. lf tanks have not been pumped out uithin the last three years, they should be punped
out now.
0 Inspection pipe is located directly over tank baffle (does not give accurate rr�asurement of solids accunulation>.
If tanks have not been punpeci out withirLthe lesi three years, t sho Ld out now.
sa
DRAINFIELD CONDITION (11-14):
D�field inspection indicates:
1 Drainfield is dry, no surfacing evident.
Sane evidence of surfacing, not critical yet.
13 Drainfield is seturated 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.):
COMME S:�C �/" p�
�
Date o nspection Sep i System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of
property, be advised that this report does not guarantee or certify that an existing system will continue to function
properly� but is merely an opi�ion of the adequacy of the system under current conditions based on the availeble
information.
This report must be kept on the premises with the system locetion 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 SEWAf�E TREATMENT
� � INSPECTION REPORT
'�� G~
9k'ESHo�'�
Owner• W,� r�� Address: Ui�G
Permit �'s: Q Dates:�(�'�b$d Contractors: K.l�✓� /�f�C�.
City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the category
checked below.
(This is �an existing system [ ] neu construction)
SYSTEM CONFORMITY (1-3):
1 "CODE SYSTEM"-A system which meets all the location, design, and construction standards of the current City
Codes, and which is operating satisfactorily by treating and disposing of the entire current sewage input
without discharging any pollutants into ground or surface waters.
2 "CONFORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the
current City Codes, but was installed according to the code in effect at the time of installation, and which
is operating satisfactorily by treating and disposing of the entire current sewage input without discharging
any pollutants into ground or surface waters.
3 ��NON-CONFORMING SYSTEM��-A prohibited system; a system located within a designated 100-year floodplain; any
system which may or may not meet all the location, design, and construction standards of the current City
Codes and 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 c�.has or [ ] has not been identified at this time. It the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDITION C5-10):
Tank inspection indicates:
5 Punpout not needed at this time.
6 Solids accunulation in tanks indicates they should be p�xnped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Tanks should be punped out as soon as possible.
8 System is discharging to the surface. 7anks must be pumped out within 48 hours to eliminate surface dischar�e.
9 Inspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe> must be installed in each
tank at next pumpout. lf tanks have not been pumped out w�thin the last three years, they should be punped
out now.
� � Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accunulation).
If tanks have not been punped out within the last three years, they should be pumped out now.
DRAINfIELD CONDITION (11-14):
Dr field inspection indicates:
Drainfie[d is dry, no surfacing evident.
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.
14 Drainfield extent and condition unknoun.
LIMITING SITE FACTORS Cslope,setbacks.etc.):
POTENTIAL FOR SYSTEM FAILURE Cdepends on soils.Water table.etc.): /��
(�
C MMENTS: � ' �
�
Date of Inspection ic 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
properlyi but is merely an opinion of the adequacy of the system under current conditions based on the available
�nformation.
This report must be kept on the pre�nises with the system locetion and punping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
On the North Shore of
Lake Minnetonka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
1335 S. Brown Rd.
� � � � Crystal Bay, MN 55323
473-7357
OWNER ��.T��o.��: Tr ADDRESS � - Lt�-° J��,
' L� (J DATES ����'RR CONTRACTORS �
PERMIT NO.S.
City Ordinance No.210 requires that each on�site sewage treatment system in Orono be inspected on a regular basis.The on-site sewage
treatment system at the above address has been inspected and appears to fall into the category checked below.
(This is � an existing system O new construction)
� � Meets or exceeds current City standards in ail respects relating to design,construction,and location.Appears to be operating
properiy.
� 2 Does not meet ali current City standards for �ew construction (1978 Cock) but in most respects appears to be designed,
located, and constructed generolly in accordance with previous codes.System appears to be functioning properly;no major
upgrading of the system is required at this time.
� 3 Does not meet current City standards in many respects relating to design,construction,or location.Appears to be operating
adequately at this time,but has a relatively high potential for future problems. No major upgrading of system is required at
this time.
� 4 System may or may not meet current City standards for design,construction or locatio�,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 othervvise 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 inspection indicates: ❑ Inapection pipe is located directly over tank baffle.1Does not
❑ Pumpout not needed at this time. give accurate measurement of solids accumulation.) If tanks
❑ Solids aecumulation 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.
❑ Solida accumulation in tanks is at a critical level. Tanks Drai field inspection indicates:
should be pumped out as soon as possible. �Drainfield is dry,no surfacing evident.
❑ System is discharging to surface. Tanks must be pumped ❑ Some evidence of surfacing,not critical yet.
� within 48 hours to eliminate surfa�discharge. ❑ Dreinfield is saturated and visibty discharging untreated
�.Inspection risers missing—tanks could not be inspected, effluent to the surface, This condition may require replace-
Inspection risera (4"dia.pipe)must be installed in each ta�k ment or additions to drai�field. Contact the City Inspector
at next vumoout_ ren A a�n�...++�o.+.+��.++ immediately.Repeirs must be completed within 90 days.
ffie last three vears_thev should be aumped out now O Drainfield extent and condition unknown,
SITE CHARACTERISTICS:
Limiting Site Factors Potential for System Failure Site Capabilities for
❑ Slope (depends on soil types,water Futu e Expansion
❑ Soil table,and system condition) �Adequate
❑ High water table �Low ❑ Fair
❑ Lot size ❑ Medium O Poor
❑ Lake,wetland,or stream ❑ High ❑ Inadequate
❑ Drainage ❑System is causing visible
sur ace di harg
COMMENTS: e
� �
►�✓ l�e n �9�''►s
�'�=�1
Date of Inspection eptic System Inspector
Note: In the e�nt 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 tunction properly,but is merely an opi�ion of the adequacy
of the system under current conditions based on the available information.
This report must be kept on the premises with system location and pumping records.
WHITE COPY/tnspector's File GOLD COPY/Homeowner
SEPTIC SYSTEM INFORMATION
STREET ADDRESS 2� LI�tG� �.//V�� /�ID(,-�
LOT�_ BLOCK � . SUBDIVISION ��}�Nr��S �E€k
MONTH AND YEAR TESTING DONE J�.ECLsy►�g� �95�
ITEMS ALREADY COMPLETED y .SO/L �p�2 f N�,S �i� P�G `7��S
NEED TO COMPLETE BEFORE ISSUING BUILDING PERMIT:
OBORINGS
OPERC TESTS .
SYSTEM DESIGN
(X ) SITE PLAN� u)�NG � D�'.A�10/� O� /��. L��`Z.L�
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