HomeMy WebLinkAboutseptic info MinnesotaPoitution SSTS Abandonment
Control Agency
520LafayetteRoadNorth Reporting Form
SC Paul,MN 55155-4194
Subsurface Sewage Treatment Systems(SSTS) Program)
Instructions
This form is offered to meet the abandonment requiremeMs of Minn.R.70802500 and Disclosure Requiremerrts of Minn.Stat.
§115.55,subd.6.Future water supp�y well placemertt can also be affected by an abandoned SSTS.
The use of this form is not mandatory;however the information on this form must be submitted to the local govemment unit(LGU)
within 90 days after the abandonmerrt.This form may be completed by a certified SSTS practitioner or by an individual who has
direct knowledge of how the system was abandoned.
Property Information
Date of abandonment: (�� Reason for abandonment: IV�__W��,�
�7�r�-
a- �' a�ec.� .Sa-:S ED( .,c._c,c�J`•�. �o.i�i-..c ar
Property owner name(s): ' :G��t�-�� ���n 5�40'-
Property owner's address: �`_s��C c ,�:„e _�t�Q�Q__,_ j v z��i e
City: O �c.,2 6 � State: ln n_ ---
Zip:
Site address(if different): _�_ -
��ri: otano -- '��t�
Zip:
Compliance Information
1. All solids and liquids removed from all tanks? Yes ❑No
Disposal Site: �('� �r �-hnn�1-
1��I
2. All electrical devices and devices coMainin�ry removed?�Yes ❑No -
Disposal Site:
3. Ali underground sewage tanks crushed and filled with soii or rodc material7 Yes ❑No or
Removed and disposed off sde? ❑Yes ❑No
Disposal Site:
4. Contaminated material�ed and disposed off site? ❑Yes ❑No
Disposal Site:
5. All underground qvities"crushed and filled with soil or rxk material� ❑Yes ❑No or.
Removed and disposed off sfte? ❑Yes ❑No
Disposal Site: ��___ .
6. Future discharge to system pertnanently denied7�es ❑No
Method(s)used:
'Contaminated materials=Distribution media,soil arsand within three feet of the sysfem bottom,distribution pipes,geotextile
fabric/rasin paper/straw,tanks,contaminated soi/around leaking tanks,any soil that recei�red sewage
from a surface failure(7080.2500 subp.3).
"Underground cavities= Cesspop/s,leeching pits,drywells,seepage pits,vault privies,pit p�ivies,pump chambers
(7080.2500 subp. 1).Does rrot include chamber media,drop boxes,or distribution boxes.
www.pca.state.mn.us • 651-296-8300 • 800-657-3864 • T7Y 651-2ffi-5332 or 800-657-3884 • �Available in altemative fortnats
wq-wwlsts4-03 • 11/21/08
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Map
Include loCation of building sewer,septic tank(s),soil dispersal system,cesspoois,seapage pits,and other pits.Also
inGude a permanent referen�point(s)and dimenaiona.
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certificatlon
1 he�ebY cee�fy the system wss abendoned Jn eooatlance with Minn.R 709D.2500�d a►ry foca/requlrements.
Name(pleaee M): -�A Tftle: �— �rV1Qll`—t�=��ws/1� �L
Addreas: �,
City: ��'� �� J-��Q�_ aR
Phone: license#'rf icable): .Z�q
Dete: Sigrmture:
www.pca.itale.mn.w • g51-288-830p • gpp.9g7_3B8q • 77y 851-282-6332 w 800-g67-38gq • Avaflable in altemattve fomrets
wp-wwlatN-03 • 11/21/08
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O O CI'TY OF ORONO
Municipal Offices
�„ � 8treet Address Mailing Address:
� �j'�' 2750 Kelley Parkway P.O.Box 66
'Z.9 �i Orono,MN 55356 Crystal Bay,MN 55323-0066
x'Es8o4
To: The Current Owner of Address 135 LUCE LINE RIDGE
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 Heal •Threat
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 compliance by:
December 31, 2007
December 31, 2010
Other
Septic Tank(s) Pump out Needed
Yes �No
The city recommends the septic tank(s) and/or lift tank be serviced and pumped out every three
(3) years. City records indicate the tank(s) were last pumped out on �qD�
The tank(s) should be cleaned through the manhole and not through the inspection pipes, this
allows for proper cleaning.
Comments:
Inspect w �"" Date of Inspection: � ���
w .,.,,
Telephone (952) 249-4600 • Fax(952) 249-4616
www.ci.orono.mn.us
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:� O\�,
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� l CITY of OIZONO
�I �,:�;;�. ,, p,,, I
'�' ''� '�•' �`� �I J Municipal Offices
,\�+' �,. �` ' ti ,
� `��' Street Address: Mailing Address:
,� ��9 ' , ' 4��'G ,' 2750 Kelley Parkway P.O. Boz 66
.k'ESB�. ,
�`� -- Orono, MN 55356 Crystal Bay, MN 55323•0066
To: The Current Owner of Address � 3� L� �� �•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 �l
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 refenal to the City Attorney for
legal action.
System Identified as Non-Compliant
Yes �No
If yes, system must be brought into compliance by:
December 31, 2007
December 31, 2010
Other '
Septic Tank�'ump out Needed
Yes �
No
The City recommends the septic tank(s) and/or lift tank be serviced and pumped
out every three years. City records indicate the tank(s) were last pumped out on
l,� .� ,�-�� . The tank(s) should be cleaned through the manhole and
not through the inspection pipes,this allows for proper cleaning.
Comments:
�
�
Inspect . Date of Inspection � d S
Telephone(9�2) 249-46Q0 � Fax(9�2)249-4616
ww�w.ci.orono.mn.us
�o� �
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�-���= CITY of ORONO
'� i����`�� � Municipal Offices
. �',, '� a;� ,�h
F .
� ���;��"���-�,��G,G Street Address: Mailing Address:
� '�'rr��' v
'91tE8Hpg' 2750 Kelley Parkway P.O. Boz 66
Orono, MN 55356 Crystal Bay, MN 55323•0066
To Current Owner: Address: � 3� L-v�� �-''"�- 1`����.-
�
City Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every two years.
The oa-site sewage treatment system at the above address has been inspected and appeazs to fall into the categories checked below.
YSTEM CONFORNIITY 1-3 : �
1 "CODE SYS'TEM" An ISTS which meets atl the location,design and construction standards of the current Orono Municipal Code.
2 "COMPLIANT SYS'TEM" An ISTS which does not meet all the location,design and construction standards of the current Orono Municipal
Code but does meet the three foot separallon requirement or two foot requirement for systems installed 1996 or earlier,and which is not failing or
an imminent tlueat to public health or safery.
3 "NON-COMFLIANT SYSTEM" A prohibited ISTS;an ISTS located within e 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 eny reason;and
any ISTS with less than three feet of unsaturated soil or sand between the distribution device and the timiting soil characteristics.
TANK CONDITION(5-7): �i
Tank inspection indicates:
5 Pumpout not needed at this time.
�Septic tanks must be pumped out this year (city code requires tanks to be pumped out once every 3 years.
Tank was last pumped \1-15-��\ ).
Make sure seatic tanks are oumaed through manhole and not through white insoection aiaes. This allows for the
proaer cleanin¢. Keeo 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.
INFIELD CONDITION 8-10 : �,
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: ���.���c.�� 'soc'k3 �k, P��-P Sc�3�'� ��k�
S„��-...�r- '2._��y ,
� �Z�—U� 1�� ���
Date of Inspecrion Matt Bolterman- Septic System Inspector
Note:In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that this report does not guarantee
or certify that an exisdng system will continue W function properly,but is merely an opinion ofthe adequacy of the system under current conditions based on the available
infoanation.
Telephone(952)249-4600 • Fax(952)249-4616
vnarav ni nrnnm m�na
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����l�?� CITY of ORONO
,� � �'�;�,�a:�, �
� '�� 5 `� " ti Municipal Offices
1 �.�� ,. ,�
��;'�`' !I�,��, G
� '��.;;���„�g� Street Addross: Mallln�Addross:
�'EggO 2150 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323•0066
Owner: �Av-,c� /�, �d e r 5 0� Address:_��� � �Cc �;�� R:��e
City Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every two yeazs.
The on-site se�vage treatment system at the above address has been inspected and appeazs to fall into the categories checked below.
SYSTEM CONFORNIITY (1-3): �
�1 °CODE SYSTEM" An ISTS which meets all the location,design and construction standards ofthe current Orono Municipal Code.
2 "COMPLIANT SYSTEM" An ISTS which does not meet all the locatioq design and construction standards af the cutrrnt Orono Municipal
Code but does meet the three foot separation requ'aemect�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-yeu flood plain,any ISTS which may
or may not meet all the location,design,or construction standards of the currecrt Orono Municipal Code and which is failing for any reason;and
any ISTS with less than three feet of unsamrated soil or sand between the distribution device and the limiting soil characteristics.
T.4NK CONDITION(5-10): s
Tank inspection indicates:
� Pumpout not needed at tlus time.
6 Tank must be pumped out this year (city code requires tanks to be pumped out every 3 yeus. Tank was lact pumped ��-�5 '�� �,
7 Solids accumulation in tanks is at a critical a criticat IeveL Tanks should be pumped out as soon as possible.
8 System is dischazging to the surface. Tarilcs 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 pumpout If tanks
have not bean pumped out within the last three years,they should be pumped out now.
10 Inspection pipe is located directly over tank baffle(does not give accurate measuremrnt of solids accumulation). If tanlcs have not bern pumped
out within the last tivee years,they should be pumped out now.
DRAIlVFIELD CONDITION 11-14 : \�
11 Drainfield is dry,no surfacing evident
12 Some evidence of surFacing,not critical yet ,
13 Drainfield is sativated and visibly discharging untreated effluert W the surface. Contact the City Inspector immediately.Repairs must be
completed withict 90 days. �
1-� Draintield extent and condition unknown
CONIl�IENTS: S�l S'�-e�-- \ookS 0� _
�"�`�' � ` �ar
Date of Inspection Septie System Inspector i
Note: In the everrt that this inspection report is used to satisfy the requiremeats for a murtgage or ather traosfer of property,be advised that this repoR does not guarantee
or certify that an eatisting system will contir►ue to function properly,but is merely an opiaion of the adequacy of the system under cucrent conditions b�ed on the availablz
info�mation.
CITY OF ORONO � O�
Municipal Offices O � O
Post Office eox 66
Crystal Bay, MN 55323-0066 a � ON-SITE SEWAGE TREATMENT
r� � INSPECTION REPORT
�' G~
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9kESH�4
Owner:��qVl � ��"IdF/�SC`� Address:__1�.1 �(ilGC. �/K.L��/ � �5�$n/�
Permit �'s: Dates:_�-'��' � ] Contractors: ���(�P�'j q �'�'
City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
The on-stte sewage treatment system at the above address has been inspected and appears to fall into the category
checked belou.
(This is�an existing system [ ] new construction)
TEM CONFORMITY 1-3 :
1 "CODE SYSTEM"-A system uhich 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
without discharging any pollutants into ground or surface waters.
2 "CONfORMING SYSTEM"-A system uhich does not meet all the location, design, and construction standards of the
current City Codes, but was installed according to the code in effect at the time of installation, and uhich
is operating satisfactorily by treating and disposing of the entire current sewage input uithout discharging
any pollutants into ground or surface waters.
3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any
system which may or may not meet all the location, design, and construction standards of the current City
Codes and uhich is failing for any reason; and any system uith less than 3 feet of unsaturated soil or sand
betueen the distribution device and the limiting soil characteristics.
(The limiting soil characteristic�has or [ ] has not been identified at this time. If the limiting soil
characteristic has not been ident' ie this classification may be subject to revision.)
TANK CONDITION (5-10):
Tank inspection indicates:
Purtipout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year to help prevent future problems.
Solids accumulation in tanks is at a critical level. 7anks should be pumped out as soon as possible.
8 System is discharging to the surface. Tanks must be pwnped 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 pumped out within the last three years, they should be pumped
out now.
10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
If tanks have not been pumped out uithin the last three years, they should be ptxnped out now.
DRAINFIELD CONDITION (11-14):
�field inspection indicates:
11 Drainfield 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
irtmediately. Repairs must be cortipleted within 90 days.
14 Drainfield extent and condition unknown.
LIMITING SITE FACTORS (slope,setbacks.etc.): I -� ,�
POTENTIAL FOR SYSTEM FAILURE (depends on soils,water table,etc.):
COMMENTS: S�
��
Date of Insp ction Septi� System Inspector
Note: [n 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� twt is merely an opinion of the adequacy of the system under current conditions based on the available
information.
This report must be kept on the premises uith the system locstion 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 SEWAdE TREATMBNT
INSPECTION REPORT
ti
ti
��9k o4�G
EsH
(f��,, J (��
Owner: �.IAI�IU ��� Address• /�
�
Permit �'s: Dates: ,,�� / C�� Contractors:
City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the category
checked below.
(7his is � an existing system [ ] new construction)
STSTEM 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 installetion, and which
is operating satisfactorily by treating and disposing of the entire current sewege 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 � has or [ ] has not been identified at this time. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDITION (5-10):
Tank inspection indicates:
� Punpout not needed at this time.
6 oltds accunulation in tanks indicates the should be out this year to help prevent future roblems.
o a cri ic
8 System is discharging to the surface. Tanks must be punped 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 �n each
tank at next punpout. If tanks have not been punped out within the last three years, they should be p�anped
out now.
10 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 punped out now.
DRAINFIELD CONDITION (11-14):
D��field inspection indicates:
(1S7 Drainfie[d is dry, no surfacing evident.
'T2 Some evidence of surfacing, not critical yet.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately. Repairs must be completed within 90 days.
14 Drainfield extent and condition unknown.
LIMITING SITE FACTORS (sloae,setbacks.etc.):
POTENTIAL FOR SYSTEM PAtLURE (decends on soils.water table,etc.): `��
COMMENTS:
Date of Inspection Sep c 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 wilt continue to function
properly� but is merely an opinion of the adequacy of the system under current conditions based on the available
informatton.
This report must be kept on the pre:nises with the system loc�tion and p�mping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
CITY OF ORONO � O�
Municipal Offices O O
Post Office eox 66
Crystal Bay, MN 55323-0066 � � ON—SITE SEWA(�E TREATMENT
r�,� , � INSPECTION REPORT
'�� G~
'�
9kESH�4'
Owner: �LJDUI(X ftW���OY� Address: �
Permit �'s: Dates:_ __�'���g 7 Contractors:
City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the category
checked below.
(This is p�]. an existing system [ ] nea construction)
SYSTEM CONfORM1TY (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
uithout 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 uaters.
3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any
system which may or may not meet all the location, design, and construction standards of the current City
Codes and which is failing for any reason; and any system with less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soil characteristics.
(The limiting soil characteristic [�has or [ ] has not been identified at this time. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDITION (5-10): �
T� inspection indicates:
5 Pumpout not needed at this time.
Solids accumulation in tanks indicates they should be punped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Yanks should be punped out as soon as possible.
8 System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface dischar�e.
9 Inspection risers missing-tanks could not be inspected. lnspection risers (4" dia. pipe) must be installed in each
tank at next p�mpout. If tanks have not been punped out within the last three years, they should be punped
out now.
10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accunulation).
[f tanks have not been punped out uithin the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14):
Dr nfield inspection indicates:
1 Drainfield is dry, no surfacing evident.
2 Some evidence of surfacing, not critical yet.
13 Drainfield is saturated and visibly discharging untreated effluent to the surtace. Contact the City [nspector
immediately. Repairs must be completed within 90 days.
14 Drainfield extent and condition unknown.
LIMITING SITE FACTORS (sloae.setbacks,etc.):
POTENTIAL FOR SYSTEM FAILURE (deoends on soils,water table,etc.): ��
COMMENTS:
Dte� Inspection S ptic System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of
property, be advised that this report does not guarantee or certify that an existing system will continue to function
properlyi but is merely an opinion of the adequacy of the system under current conditions based on the available
informatton.
This report must be kept on the premises with the system locstion and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
On the North Shore o f
Lake Minnetonka
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
1335 S. Brown Rd.
� � � Crystal Bay,MN 55323
473-7357
OWNER �✓� � n/�'Pr�� ADDRESS �
PERMITNO.'S. ��T� DATES -- � a7 07 CONTRACTORS
City Ordinance No,210 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.The onsite sewage
treatment system at the above address has been i�spected and appears to fail into the category checked below.
(This is �an existing system ❑ new construction)
� � Meets or exceeds current City standards in all respects relating to design,construction,and location.Appears to be operating
properly.
� 2 Dces not meet all current City standards for new construction (1978 Code) but in most respects appears to be designed,
located, and constructed generally in accordance with previous codes.System appears to be functioning properly;no major
upgrading of the system is required at this time.
� 3 Does not meet current City standards in many respects relating to design,construction,or location.Appears to be operating
adequately at this time, but has a relatively high potential for future problems. No major upgrading of system is required at
this time.
� 4 System may or may not meet current City standards for design,construction or location,but is failing to properly treat and
dispose of the current input,and is endangering a water supply,or is a wurce ot pollution to surface or groundwaters,or is
creating a safety hazard,or is otherwise creating a public nuisance.Please contact the City Inspector to discuss system repair/
replacement procedures. If drainfield replacement is�ecessary,soil testing will usually be required,a�d 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 actio�)
Tan mspection indicates: ❑ Inapection pipe is located directly over tank baffle.(Does not
�Pumpout not needed at this time. give accurate me�ureme�t of solids accumulation.) If tanks
❑ Solids accumulation in tanks indicates they should be pump- have not been pumped out within the last three years,they
ed out this year to help prevent future problems. ahould be pumped out now.
❑ Soli� accumulation in tenka ia et a critical level. 7anks Drainfield inapection indicates:
should be pumped out as aoon as possible. �Drainfield is dry,no surfacing evident.
❑ System is discharging to surface. Tanks must be pumped ❑ Some evidence of surfacing,not critical yet.
within 48 hours to eliminate surface discharge. ❑ Oreinfield is saturated a�d visibly discharging untreated
❑ I�spection risen missing—tanks could not be inspected, effluent to the surface. This condition may require replace-
Inspection risers (4"dia. pipe)must be installed in each tank ment or additions to drainfield. Contact the City Inspector
at next pumpout. If tanks have not been pumped out within immediately.Repairs must be completed within 90 days.
the last three years,they should be pumped out now. ❑ Drainfield extent and condition unknown.
SITE CHARACTERISTICS:
Limiting Site Factors Potential for System Failure Site 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 ❑Poor
❑ Lake,wetland,or stream ❑ High ❑ Inadequate
❑ Drainage ❑System is causing visible
surface discharge.
COMMENTS:
/�J'��
Date of Inspection ptic System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that
this report does not guarantee or certity that an exisfing system will continue to function properly,but is merely an opinion of the adequacy
of the system under current conditions based on the available informatio�.
This report must be kept on the premises with system location and pumping records.
WHITE COPY/Inspector's File GOLD COPY/Homeowner