HomeMy WebLinkAboutseptic info Minnesota Po1{ution Compliance Inspection Form
Control Agency
szo�3fay��ce Ro�d No�tf, Existing Subsurface Sewage Treatment Systems (SSTS)
St.Paul,MN 55155 4194 Doc Type:Complrance and Enlorcement
_ _
Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes:
requirements and attached forms—additional local requirements may also apply.
Submit completed form to Local Unit of Government(LUG)and system owner
within 15 days
$)/StE'I'Tl $tdtUS
System status on date(mm/dd/yyyy): 7/28/2016
� Compliant — Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance
(Valid tor 3 years from report date, unless shorter trme (See Upgrade Requirements on page 3.)
frame outlined i�1 Loca!Ordinance.)
Reason(s)for noncompliance (check all applicable)
❑ Impact on Public Health (Compliance Component#1)-lmminent threat to public health and safety
❑ Other Compliance Conditions (Compfiance Component#3)-Immrnent threat to publrc health and safety
❑ Tank Integrity(Complrance Component#2)-Failing to protecf groundwater
❑ Other Compliance Conditions(Complrance Component#3)-Failing to protect groundwafer
❑ Soil Separation (Compliance Component#4)-Failir�g to protect groundwater
❑ Operating permiUmonitoring plan requirements(Compliance Component#5)-Noncompliant
Property Information Parcel ID#or Sec/Twp/Range:
. _ _ ___
Property address: 1200 Phillips Dr. Orono,Mn 55356 Reason for inspection: Sale
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Property owner: Ned Dau Owner's phone: 612-280-8119
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or _ __.
Owner's representative: Representative phone:
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Local regulafory authority: Regulatory authority phone:
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Brief system description: 5 bedroom Mound System
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Comments or recommendations:
system has 12"of cover over the top. It is recommended that grass be planted over the mound system.
Certification
1 hereby certi(y thaf a!I the necessary information has been gathered to determine the compliance stafus of fhis system. No
determinatron of future sysiem performance has been nor can be made due to unknown conditions during system construction,
possrble abuse o(the system. rnadequate maintenance, or future water usage.
Inspector name: Josh Swedfund Certification number. C1659
Business name: Swedlund Septic�\e License number: 2502
Inspector signature: �� Phone number: 952-873-3292
Necessary or Localty Required Attachments
� Soil boring logs � System/As-built drawing ❑ Forms per local ordinance
❑ Other information(list):
__
www.pca.state.mn.us • 651-296•6300 • 800-657-3864 • 1TY 651-282-5332 or 800-657-3864 • Available in atternative formats
wq-wwists4-31 • 3/16/12 Page t oJ 3
Property address: 1200 Phillips Dr.Orono Mn 55356 Inspector initials/Date: JS � 7/28/2016
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(mm/dd/YYYY)
1. Impact on PubliC Health—Compliance component#1 of 5
Compliance criteria: Verification method(s):
_ __. _
System discharges sewage to the ❑ Yes � No � Searched for surface outlet
ground surface. ___ � Searched for seeping in yard/backup in home
.__._.
System discharges sewage to drain ❑ Yes � No ❑ Excessive ponding in soil system/D-boxes
tile or surface waters. __ ❑ Homeowner testimony(See CommenrsiExp�anatron)
System causes sewage backup into ❑ Yes � No ❑ ��Black soii"above soil dispersai system
dwelling or establishment.
____. _ ----._ _.....__ _.__ _ _.. ____-- --___ ..... __ ❑ System requires"emergency"pumping
Any"yes"answer above indicates the ❑ Performed dye test
system is an imminent threat to public ❑ Unable to verify(See Comments/Explanation)
health and safety.
_.. ___ __,, __ ❑ Other methods not listed (SQe Comments/Explanarion)
__ _
Comments/Explanati on:
2. Tank Integrity—Compliance component#2 of 5
Compliance criteria: Verification method(sj:
_ _ _. _ _
System consists of a seepage pit, ❑ Yes � No ❑ Probed tank(s)bottom
cesspool, drywell,or leaching pit.
� Examined construction records
Seepage pits meeting 7080.2550 may be
compliant iiallowed rn toca!ordinartce. ❑ Examined Tank Integrity Form (Artacn)
____ __ _ . _ _
❑ Observed liquid levet below operating depth
Sewage tank(s)leak below their ❑ Yes � No
designed operating depth. � Examined empty(pumped)tanks(s}
If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil"
_.__..._ _ _
___ _
Any "yes"answer above indicates the nab�e to verify�see comme�:sieXpianarron�
system is failing to protect groundwater. ❑ Other methods not listed (See Comments/Explanation)
__._ _ ---.._ _. __.._... ___._._ _._.__. _.._
Com ments/Explanation:
3. Othe�Co111p11d�Ce Collditi011s—Compliance component#3 of 5
a. Maintenance hole covers are damagerl,cracked.unsecured,or appear to be structurafly unsound. ❑Yes' �No ❑Unknown
b. Other issues(e�ectricai hazards.etc.)to immediately and adversely impact public health or safety, p Yes' �No ❑Unknown
*System is an imminent threat to public hea/th and safety.
Explain:
c. System is non-protective of ground water for other conditions as determined by inspector. p Yes• �No
*System is faiung to protect groundwater.
Explain:
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www.pca.scate.mn.us • 651•296•6300 • 800-657•3864 • TTY 651-282•5332 or 8�-657-3864 • Availabte in alternative formats
wq-wwis[s4-31 • 3116/12 Page 2 of 3
Property address: 1200 Phdhps_Dr Orono Mn 55356 ___ Inspector initials/Date: JS �_7/28l2Q16
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(mm/dd/YYYY) __
4. Soil Separation —Compliance component#4 of 5
Date of instaQation: 5/26/1994 ❑ Unknown Verification method(s):
__ _ _ _ _._.. __
(mm/dd/yyyy)
Soil observation does not expire. Previous soil
ShorelandlWelihead protection/Food beverage � Yes � No observations by two independent parties are sufficient,
iodging? unless site condifrons have been altered or foca/
Compliance criteria: requirements differ.
_ _ . .
For systems built prior to April 9, 1996, and � Yes ❑ No � Conducted soil observation(s)(Arracn bor;ng iogs)
nof located in Shorefand or Wel/head ❑ Two previous verifications(Attach boring logs)
Protection Area or not serving a food,
beverage or Jodging eslablishment: , ❑ Not applicable(Hotd;ng rank(s).no drainfie�d)
Drainfield has at least a two-foot vertical ❑ Unable to verify(5ee CommenrsiExpJanation)
separation distance from periodically ❑ Other�See CommentsiExp�anarion)
saturated soil or bedrock.
Non-performance systems built April 1. ❑ Yes ❑ No CommentslExplanation:
1996, or later or for non-performance
systems located in Shoreland or We/lhead Boring:
Protection Areas or s�rving a food, 1-10"10YR 2/2 Loam
beverage, or lodging establishment:
11-18"10YR 4!4 Clay Loam
Drainfield has a three-foot vertical
separation distance from periodically Motts @ 18"
saturated soil or bedrock."
_ ___ :_ _. . _
"Experimenta!", "Other': or "Performance" , ❑ Yes ❑ No Indicate depths or elevations
sysfems built under pre-2008 Rules; Type IV ' _.,_..----- --._-- _ __..... __._.__ _ . ___
or V systems bui(t under 2008 RuleS(7080. , A. eottom of distribution media +12"
_ __ _ _
2350 or 7080.2400 (Advanced Inspector '
License required) B. Periodically saturated soillbedrak 18"
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Drainfield meets the designed vertical
separation distance from periodically C System separation 18
_ _ ___ __-__ _. . .. ..._ .. .. _.
saturated soil or bedrock.
' D. Required compliance separation' 24"
Any "no"answer above indicates the system is 'May be reduced up to 15 percent if allowed by Local
failing to protect groundwater. Ordinance.
5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 � Not applicable
Is the system operated under an Operating Permit? ❑ Yes ❑ No If"yes",A below is required
Is the system required to employ a Nitrogen BMP? ❑ Yes ❑ No If"yes",B below is required
BMP=Best Il�anagemenf Practice(s)specified in fhe system design
If the answer to both questions is "no'; this section does not need to be compteted.
Compliance criteria
__.. _. _.... __ _ _.__ . __.__ __ __
a. Operating Permit number.
_. _ _ ❑ Yes ❑ No
Have the Operating Permit requirements been met?
b. Is the required nitrogen BMP in place and properly functioning? ❑ Yes ❑ No
Any "no"answer indicates Noncompliance.
Upgrade Requirements(Minn.Stal.§115.55j An imminent threat to pubJic health and safety(ITPHS)must be upgraded,replaced,or ds use
discontinued wrthin ten months oi receipt of this notrce or wdhfn a shorter period i(required by local ordinance.If the sysfem is failing to protect
ground water.!he systertt r»ust be upgraded.replaced.or its use discontinued within the time required by local ordinance.!f an existing system
is not�ailing as delined rn law.and has at least two feet of design sorl separation,U�en the system need not be upgraded.repaired.�eplaced,or
ifs use discontinued.notwdhstanding any focaf ordinance tRat rs more strict. This provision does rtot apply to systems in shoreland areas.
WelJhead Protection Areas,or fhose used in connection with lood.beverage,and lodging establishments as defined in law.
_
www.pca.state.mn.us • 657-296-6300 • 800-657-3864 • TTY 651•282•5332 or 800-657-3864 • Available in al[ernative formats
wq•wwrs[s4-31 • 3/?6/12 Paqe 3 of 3
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� SEPTIC SYSTEM INVENTORY
Site Address: 1200 Phillips Dr PID 27-118-23-32-0009
Owner Name: Edwa�d 8�Michelle Dau
Owner Address: 1200 Phillips Dr Long Lake MN 55356-
BuildingTvpe: residence Installer: E.J. Peterson Co.
Date of Permit: 5/26l94
Svstem Tvpe: mound BR's Designed for 5
In Musa?: No Shoreland?: YES
SEPTIC TANKS:
Material: precast concrete Capacity: 1300, 1300, 1300 Tank Filter:
DRAINFIELD:
Treatment Area: 92"39 Soil Bo�ing: yes DF Ht above Wt: 3
WELL DATA
Setbacks-Well Tanks: Well DF: Report In File: Depth:
INSPECTION RECORDS UT RECORDS
----- - ----
�----........ ---�
Date Notes Date GallonsOfliquid
12/1/2006 Okay �� 11/6/2013 3000 ;
9/23/2004 Okay � 11/13/2012 i
9/24/2003 no surfa�ing,pump tanks,replace insp cap on 2nd tank ; 5/3/2010 0 �
9/30/2002 no surfacing,pump tanks �' S/22/2007
i�- -- ----- -�
6/27/2000 no surfacing, pump tanks �
8/26/1998 no surfacing-pump tanks '
5/3/1995 no surfacing I
' 10/13/1994 installation �
---- ------------�
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� �� . M �� CITY of OIZOI�T�
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��' „.',���'�f;F,',`':;�G~'�'� Street Address: Mailing Address:
• ,�.kE$�p'4',.;.. � 2150 Kelley Parkway P.O. Boz 66
- - ..�...� Orono, MN 55356 Crystal Bay, MN 55323•0066
To: The Cun•ent Owner of Address /��[�'� j7 k� � ���--5
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 He th 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.j
System Identified as Non-Compliant
Yes =�No
If yes, system must be brought into compliance by:
December 31, 2007 �
December 31, 2010
Other
Septic Tank(s) Pump 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
�, `�'ti�� . The tank(s) should be cleaned throtigh the manhole and
not tluough the inspection pipes, this allows for proper cleaning.
Gomments:
� �
Ins ector:�''� Date of Inspection �v� -C��
P
Telephonz (9�2) 2=;9-�6Q0 � Fax (9�2j ?49-46ifi
w«rs.ci.orono.mn.us
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� ��� M CITY of ORONO
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���,t� .�������,G Street Address: °ISa.-a49—y6o O Mailing Addrou:
` '� '`�'�;p�"� 2150 Kel ley Parkway P.O. Box 66
�;Es�.�
� - Orono, MN 55356 Crystal Bay, MN 55323-0066
To Current Owner: Address: �a00 P�;����15 ��.
City Ordinance 199 requires t9�at each existing on-site sewage treatment system in Orono be inspected every two years.
The on-site sewage treaiment system at the above address has been inspected and appears to fall into the categories checked below.
SYSTEM CONFORMTT'Y 1-3 : �
1 `CODE SYSTEM"An LSTS which�ets all the location,design and construction standerds of the cuirent Orono Municipal Code.
2 "COMPLIANT SYSTEM" An ISTS wluch does not meet all t�e location,design and construction standards of the current Orono
Municipal Code but does meet the duee foot separation requirement or two foot requir�ent for systems installed 1996 or earlier,and
which is not failing or an i�inent threat to public health or safety.
3 "NON-COMPLIANT SYSTEM" A prohibited LSTS;an ISTS located within a designated 100-year flood plain,any ISTS which may
or may not meet all the location,design,or construction standards of the curr�t Orono Municipal Code and which is failing for any
reason;and any ISTS with less than duee feet of unsaturated soil or sand between the distribution device and the limiting soil characteristics.
TANK CONDTTION(5-7): �
Tank inspection indicates:
�51 Pumpout not needed at this time.
� Septic tanks must be pumped out this year (city code recommends tanks to be pumped out once every 3 years.
Tank was last pumped ).
Make sure seatic tanks are numaed through manhole and not throu¢h white insaection aiaes. This allows for t6e uroaer
cleaning. Kcea water sotteer and iron filter discdaree out of seatic svstem to arolonQ life of drainfield. Ask aumaer to test
alarm float to verifv alarm . still workin¢in vour house. The alarm warns owner t6at seataee is about to backun into basement
7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank. If
tanks have not been pumped out within the last three years,they should be pumped out now.
DRAIlVFIELD CONDTITON 8-10 : �
8 Drainfield is dry,no surfacing evident.
9 Some evidence of surfacing,not critical yet.
i0 Drainfield is saturated and visibiy discharging untreated ef�luent to the surface. Contact the City Inspector
immediately.Repairs must be completed within 9U days.
co�rrrs: Me,,� lonks ol:_ Pv� Stp3.t t��c.s a�«
v c� 3 vta�s _
�—�-6� �
Date of Inspection Matt Bolterman- Septic Sysk,m Inspector
Note: In the eve�nt that this inspection report is used to satisfy the requirements for a mortgage or otha trsnssfer of property,be advised that this report dces '
not gusrantoe or catify that an existing system will continue to function properly, but is merely an opinion of the adequacy of the syst� under curr�t
conditions based on the avaiiable infaamation.
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`���� �'���I`^`+��, �j'�' biunicipal Offices
' '�"` '� Street Addreu:
"��� g Mailing Address:
�K� 2750 Kelley Parkway P.O. Box 66
Orono. MN 55356� � Crystal Bay, MN 55323-006
� 95d-�y9-46o0
To Cu.-rent Owner: Address:_ (a00 ��.����ps . Q t'�'
City Ordinance I99 requires that each existin�on-site sewage treatment system in Orono be inspected every two years.
The on-site sewa�e treatment system at the above address has been inspected and appears to fall into the categories checked below.
SYSTEM CONFORI�tITY (1-3): �
Q"CODE SYSTEM"An ISTS which meecs aIi the locadon,design and eonsuuction standards of the eurrtnt Orono btunicipal Code.
2 "CO�LIANT SYSTEM" M ISTS which does not meet ali the locaeion,daim and eonstruction standards of the eurtent Orono bfunicipal
Code but daes meet the three foot separatio�nquiremcnt or two foot rcquirement for rystems installed 1996 or earlier.and which is aot failing or
,an imminent thr¢at to pubtie health or saFery.
3 "NON-CONiPLIANT SYSTEM" A prohibited iSTS;an ISTS lacazed within a duignated 100-year tlaod plain,any ISTS which may
or may not meeE a11 the location.duian,or eonstracuon standards of tJie eurrent Orono Municipal Code and which is failing for any reason;and
any ISTS with leu than three fcet of uruaturated sol or sand between the distribution device and the limidno soil ehuacteristiu.
TANK CONDITION(5:71: C
Tanl:inspectian indicates: � . "
5 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 yeazs.
Tank was last purnped_ �k�.o,�•� � .
1�Iake sure seatic tanfis are numned throuah manhole and not throuQh white inspection oipes
This alio�+s for the�roner clean�n?.
7 Inspection risers missin�tanlcs could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank.
D INFIELD CONDITION -!0 : �
8 Dninfield is dry�no surfacino evident.
Some evidence oFsurfacing,not critical yeG •
10 Drainfield is saturated and visbly dischargin�uncreated effluent to the surface. Contact the City Inspector
immediately.Repairs must be comp�eted within 90 days.
C01�1�fENTS: ��^ ���� Sc �,- L ����1� cU� �
� � �0 O C��r- �� C�TS4�,
'. t� 'N �a� L o r a�,1� , ��c e� � C a o� S Cc a►. ;�S e�fi'��.
_SS'.Q'� � �4 ti� C o ,��f C a Q 5 ..... � ' �'1- � ,15�- E,.v'�' '1-�D �,6� �'
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_ � �
Date of Inspection hiatt Boiterman- Se hc S em I
F � yst asptctoc
Note: In the cvent that�tiis uupecdon repoR is used W sstisfy the rcquiremenes far a mactgaae orothutransferofpro�.+c .ry�be advised that this rcFort dou notgu=��:=
or certify t�st an existina rystem will continae to function pro pedy,but is merely an opinion of the adequary of the syster.i ander eurrenteonditlons based on the availab�
infocmadan.
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�,!, � ,���j�`,.} � CITY of ORONO
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.� , �<1 rq;��G Street Addrosa: Matilna Addreu:
��+gg0 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
A
July 5, 2000
Jeffrey& Kristin Eva.nson
1200 Phillips Drive
Long Lake, Mn 55356
Dear Mr. & Nlrs. Evanson:
An inspection of your septic system was conducted on June 27, 2000. A summary of the inspection
is below.
Septic Tank Co�dition
1. Pumpout needed within one year (l�st pumpout date unknown).
The septic system is a compliant system, meaning it meets all or most current City and State
Standards. Enclosed is a list of licensed contractors who work in Orono on a regular basis. This
list is enclosed simply for your reference in case your septic system needs maintenance in the future.
Also enclosed is a fact sheet explaining your septic system and how it functions. Finally, an as-built
drawing is enclosed showing the approximate location of the septic system.
If you have any questions regarding this report, please contact me at the City Offices at 249-4600.
Res ectfully,
. .�'�
Chris Pence
On-Site Systems Manager
Enclosures
In the event this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,
be advised that this report does no guarantee or certify the 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 informatioa
This report must be kept on the premises with the system location and pumping records.
Telephone(952)249-0600 • Fax(952)249-4616
www ci.orono.mn.us
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; �,, ,� CITY of ORUNO
� !� Municipal Offices
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�,�9 � ` � :�G Street Address: Mailing Address:
�'EgHOg�:- 2750 Kelley Parkway P.O. Box 66
__ � Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: 'Q U 1 1J � \ Address: 1200 Phillips Dr.
Permit #'s: 6114 Dates: 5/26/94 Contractors: E. J. Peterson Co.
(This is [X] an existing system [ ] new construction) .
STEM COMPLIANCE (1-3) : 1
l Code System: Meets or exceeds current City standards in all respects relatinq 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 bottor.m of
the drainfield and the saturated soil level.
(The saturated soil level is [�] or is not [ ] identified under this septic system. If the
saturated soil level is not identified, this classification is subject to revision.)
NK 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 accumulatic>n. 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.,
(The tanks are [Y] or are not [ ] water tight or the condition is [ ] unknown. If the tanks
are not confirme�to be watertight, this classification is subject to revision.)
INFIELD CONDITION (11-14) : 11
1 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 surfa.ce. 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:
�-��`�'� � �
Date of Inspection Se i System Inspector
Note: In the event that this inspection report is used to satisfy the require:nents for a
transfer of property, this report does not guarantee that an existing system will continue to
function properly, but indicates the operation of the system under current conditions.
Telephone (612) 473-7357 • FAX 473-0510
SWF.DLUND SEPTIC SERVICE RECEIVED
9520 L,aketown Road
• - ' - - Chaska, MN 55318 ,J�� p � 1997
Mi�uiesota Pollutlon Control Agency (MPCA) ��-�Y OF O q��FT
Inspection �'orm for Existing Septic Systems
— '
pATE�F1�LSPF,�'TI�)N;�O 2`r 7� T1ME: 7, •a' �^'��WEA7HEK CONUI"f1QNS:C��'�„�, IS1'S PERMI7 NUMBER: 39a
RRA$OJd F(1R IvtiPF.('TION ' . �)
O Bcdn�i�rn or bathrcw?m adAition Property rr•ner{s) ���5 Telephane O
�>v�,;�,« Site Address_ ao �� //�aS' D Q City �
� ►— • '/ -
()Co Iaint Zin COde COUnty fyE.vr�
1
Prn�rty Trans(cr Flte No. ownsliip Name
O Qther Is s�slem npcned up'! Y Full P�tli�l
�Y�T��� , 9 .
Has lanlc(s)ever been pumped? �r1 Ycyr System�uflt�_._
1(Yes,huw oftenl 3 s Fo�what�easqn:�routinaly �basa��cnt buc:kup0 sluggish plumbing0 other
Any rcpnir done un sya�rm? Y Wha� � When By whum
C's:ge: O o,he.est��lisl�n,er,,E7d,•�:lli��C'? se.^„an�!Q nth:� _ No.9xdroa�;�s - hb. of acupants
Wolcr uafn�appliances: 1'�lothcs wazhu 19��shwasher�9(,arbagr dirposnl O Whulpool bnth OWnter tonditioning unit O Sdf-c►eaning humidifiu In(urnuce M1tAresl
Surface Water: = h from which type of surfeee�watcr O riveA lnk� streArTO other _�_�
(Check appropn�te sewer system eomponent 3nd indiFate Iocation on site sketch on back oF Form).
Tank s : Tank(s) Materinl: Soll Treatment Svstem: Other;
�' Scplic lank �,Fibcrglass ; �rock trcnch �altemative system (identiFy type)
Acri,bic tank �Plastic �gravcllws Irrnc�h �experimental system (identify type)
�Pump tank _,�tctal I ^chambcr lrench _alhcr(idrntify typc)
_Holding lank �Concrete I �epage bed _ �
�Other ,� _mound
/ � at-grEidc �
T�nk(s)Si���/2`S�_�atx Soll treslmen�area Flze(s): 3 9�_ � z Ry,(Y,
I
C:O\qFC.T,�!�(`F.[NtipF.('TI(lN• I
Ls_thrrz vr hi�:the[c:_�v_c.���Fn anv cvidencc oF: es e Ex I i
Dischargt of stw��c tv lhc ground surFacc7 yE� _
pischarse of�ewa�;t to�surf�ctµ-aler? ; YES '
A serpage pit,drywell,cessp�l or leaChing piI? YES O
Less �han three feet of rertical separation between tfle soil treatment system
h��tti�m and�aturated si,it Ur bedrock? Y�S
StW16z V1C{:ll(f It1I0l�N'elling ur oth�r tstablishmenth YES N
Situations with the potential to inunediately and adversely ittlpact ur thr�nten
p�hi:�r,��!;h or saf�:,� YES r�
• if Y�S w•as an5wered for any�of�he above qu�stiotls,the systtm Is failind Accordin �o M�nn.R,ch.7080.0060.
ST T �S OF T .SyST ,M I
Base.d on the compliance lnspection conducted nbo��e the s ste�i�atatus is -//v ���/" /� A�� �
y ,lherefore,
/����— �� n�� J I A� {Choose: in complianct pR failing )
this docume�t Is a _ �- l..' C �
(Choose: Ccrtificate of Compliance OR Nptice of I�oncotnplianct ) �
� ---
CERTIFICA'(TnN �
I hcreby cuiify as a statc of�.tinnesota licensed Inspector,besigner f or Qualified Employee that my obs�rvations r�corded on this form ue
Hccuratt as uf the datt al tht tnp of�his Form[or the 6ite statcd ahove. No de.ternlination of future hydraulic performance can be made due tu
unknown cundilions during s��s�em construction,future water usagc over thc life of thc sy<c�:�;, abuse of thc system,and/or inadequate
maintenance a11 of u hich will adversefy afFecl the life of Ihe syslem. ,
{n�pcclor's namc�� �4��d�L' /v � Yhunc No� 2-i'"�-�-� •�9J�
� Liccnsc andbr Rcgistration Nurnber
(plcesc.print)
ln<pe��or's s�gn:,lure-- � Datc � —L� ^ 9/
� �__
�913 Phillips
Paqe 2 - Septic Review
To summarize:
�lO�TH LOT - Primary: shallow trenches and curtain drain;
Alternate: Mound; 8ou8e site restricted to lawer,
wetter soils.
S4UTd LOT - prfmary and Alternate: Mound; problems with
size of sites, nearness to plat road, drainaqe from plat
road; poor soils in house location. This is a POOx lot.
EXISI�IG HOUSE - Existinq systesn may extend paat proposed lot
. line. �io alternate �ite teate8. Existianq system
condition and locatfon to be confixmed.
F�1ST LOT - Primary and Alternate z Standard trenchea; �lo
problems, but sites are located centrally on property.
Suqgested further action:
1. Test an additional aite on the South Lat - CQnsider
whether we should accept thi,s as a realistic buildable lot.
2. Test for alternate site for existinq house.
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Nov 06 13 06:49p 763-213-0695 p.1
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• sySt@1f1 statUS . _
s���a��raa�r�x .�1 --� ��3
� Q�Comp�fa�—Cerfi�ica�s o�f Comptiau�ce � ❑Nonoanpliat�t—Notice o!Nanoompliance
... _. ([�alt�lhF3lrg+vsl�m..aelannt�s ur►Ie�e�-.�rr�e -� `-�- � ����o+z-P.��I . _ . .
. -fra�t�e au(Br�ed in Loc�l Or�n�n�e) � � . - �
R@aS011(S)'�Or IlpllCo�l�Af��CI)��!8f�lfC�6/ej - - . .
� ��inp�t�pubt��tea�,(. �tj—�,er�r�to p�,a��a�d sa�. � .
O othec Corr�piance condior�s( . ccm�ao►,er,r�'s�-rrr»�dnent u�r+aaf fo p�c ne�r arrd sal�► . -
. Q Taroc i�eBritY(Co�pl�erxae �21-Fa�ng�o waEact grvuod�r � .
� - �fllhefCauipianoeCa�ons C.ampar�ent�--Far'�r�.#ipofe�ct�arsrdw�er . .
� C�Sou SePeu�/iori lC�r�e #�-FaNri�in P►o�c#&�r
❑oP��rroni�or�ns Ptar+�i����?—�a�can�c�nt
_ Ptoperty Informatfon_ _ ��or�'wprRs�e: . -
Pc+operl�►ad�itea� � l��E�hse�fte�soe�foritsped�a: .
Propert�°w"er. . . _ dwne�s#� �,,�-��Sa-o y/d 4 �
o��� -��a� �1� -g I� -3 �4��
��'�Y� ' R�'Y�5►P�a .
Brief syst�rn descrip$an; - �
Coerur�ents or .
Cel'ti'f1C�Of1 � - _ .
1 her+abyG9r�fy th�t aJl the rtecessary irr�arma�inn hes bae+n g�eHrered b de��e the acmpJf�iae ataWs of Lhis s�ein.Afo
de�arrn6n�n af Ardiria sy�p per/orr�.'�e li�s bee�n rrcr can be mede c�ue��uNaiior�an aorrd�Tawa d��rin�sys�em car�ruc6an,
po�le abtrs�s d�h+a s1�►�r�qt� or f�iiu�w�teru4ag�e ,
���� c.�asc�,�: �� 8 b� -
�-�r�_ � �.,� 3
i����: - . . ���: --�� - o
Necessary or �oc�aUy Required Attachn�er�ts '
j$�soi1 boring�ogs �ns-b�drew;r�g --�--- � �fo�ma p�r tocst a�,�anos - . -
❑Other in�orir�atlon¢s� � .
www_pca�snn.ra • 461-296-630C � Il00-b57-3864 . TfY 65f-2ffi-5332 ar'800�467•3a64 • Av�lable in�fonaatt
wq-wwlsts4-3! • 1�24/f2 . ' -
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Nov 0613 06:50p 763-213-0695 p.2
Co� fiance cr�er"ra: � Ver�9cation rne�rod(s�:
, Sys#em d�e sewage to the ❑Yes �No �Seard�ed for surFaoe ouNet `
round surface. � Seardied fnrjseepn9�Y�P in home
System disc�arge sewag�to drairt�le � ❑Yes �No ❑ Excessive pa�diAg in soil systertUD-booces
or surFaoe wafers. Hameo+emer testrnony�Se�e ' )
{7� [�'Black so�'above sa'f d�persal system
System cause ae�iage badoup iri6o ❑Yes P'�--NO �( �em�1����9�1�Pu�9�
dwefGng or estabC�nent �
Any"yes"answerabove indicafes ffie sysf+esm is . �-P�oaned tiye test _ .
en lmminerrt Tlrreat to PubNc HealEf�and Saf+e�jr. ❑ Ur�able#o verify(See �
❑ Other rt�ttl0ds�Ot fested(See Cornm�ntslBrpJana[ion)
CommentsiEx�ianatim: � �
� Tank Inte�ity—Compfiance oomponerrt�2 of 5 � - ,
Com ance pitar#at- - Yerification metl�od(s):
System c�ns�sts aFf a seepa9e Qit. Q Yes �No .0 Probed tank(s)bottom
cesspool,dryweN.ar�fiing pit � �. � Examfrted oo�sUuction r�eootds -
Seepag+epits meeGig 708Q25S0 meYbe � � Eacamined Tank infiegrsty Form(Attadi)
' ,fsMowedinlocalaer�►m�ae. •
Sewage ta�k(s)leak below i�eF ❑Yes �No ; � Observed�q�Ptl►{P��P�?�p���� _ .
desi ned ' d - - ��
If yes,which�ewage tarrc(aj i�ks: ❑ Probed outside tantc(s)for"bladc soil' � •
Any'Sres"answer above in�cates the � tfnati�e to veriiy�s�c�or,».,�e�aon� .
syst+em is Failing t+o Prote�Groundwater. _ O other metnods not�ed(see co�r,e.,cs�xpra►r�onl -
cor�ur�er�lEx�r�a�ion: . . _
� Other Campliar�ce Conditions—Comp�ance component#3 af 5
�. . .
a Mairstenar�ce frofe covefs ane damaged,cxadaed,un�eared.or apF�ear fiu strtod�alh►ur�owid- �Yes' �No ❑Unknanm
b. Other i�(elecerar�tiazeras,�c.j eo inrr�ategr and ad�rsely imp�ct pubr�c t�eallh or safety. �res' �No ❑udoiown
"5ysfem�s a.,i�m,er►rttireat t+o put�i'ic heafth and�fetyr - .
. 6cpEain: .
c. Sy�em is non-�ve of ground wa6erfior o�er oondi�ans as detertnined by ins�+or Q Yes' �No
'SSast+em Is fa�Ting fo p�►o�ect g�aundw�i� , - .
E�lain: �
iww.pra.stat��an.us '► 651-296-630q • 800-657-3864 1'TY 651-2�-5332 or 800-657=3864 • Avaitable in alDernative tormats
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Nov 06 13 06:50p 763-213-0695 p.3
�. Soi! Separation—Compi�ance component�f4 of 5
Oate of in�llation: _��� ❑U� YeNfication me�od(s�; '
�o���0��� �Yes ❑Na Sa7 a�s�rv�tion does not exp�+e.Pre�ious sorl
obse�vatf+oRs Dy two indepenrle»t pa►ties are sr�f'rclerat,
Co nce crii�ia: rmless srTe c arraGt;ons have be�en aA�ere�av�Aoca!
Forsystexns b�r p�Orto,qpM 1, rsgs.arld ❑Yes ❑nro ��,�ts dr�ar.
►1ot locafied in.ShorHanol or N�INread � Conducted saf observa�on(s)(A�arah borinq bgsl
Proteclion Ar�e ornotsewing a t+ooc� ❑ Two pre�rious veri�ia�,a(AaFedr ba�ngMgsl
beveiage orloafg�}�g��' ❑ Nd appricable[Hofa6ris iank(s�,rno�infielrll
Drainfreld has at i�st a lwo-foot voertical Q Uhable b ve�ify(See�Cammentsi�zplanationl
separatian dlstartca from periodicaBy
s�rated soi or bedrock. ❑ Ofher(See � .
Nae-Perfo�mance systems bre7t Apri11, (�Yes ❑No Commenls/L�xplana�on:
9996,orlaGerorfornnrr perfomtance
systetns bcate�d ti�Sl�oreland or We�Vfread
Pr�t+�cUori Areas orse�virg a f�d,
��a►'�+9 esfab�isl�
Orainfield has a three-fioot+rertical
se�ration distarw�from perio�iCapp
saWr�ed sail or bedrr�ck.*
,FxAerimen[al:Olher; or perfio�»aenae' ❑Yes ❑No ItuGcabe de of elevatiw�s
sys6ems bur7f underpre-20Q�8 Rule�Type 1V
or V syster►►s b!/Rf W 1de�r 2U08 Rr�feS(7080. , R. Boqom of distrilx�tion rsiedia - I
2350 a'7080.24Q0 (Adv�noed tr�spe�ctor
LiCense requiraae� & Periodica sahnated sa7fbedrodc /
arair�ld mee�s the designed verticat . . . i
separation distance from periadic�ly C'
sahuatect soil o�bedrodc. D. uired • �j �
�QDy"AO"8►ISyV6r'860Y@ jlfdlCB�BS�3y5El�fl/IS `May be reduoed up bo'!5 per�nt if�bwed by Lopl
Failfng to Profect Groru�ahvater Ordir�,oe.
5. Operating PeTm�'it and Nitrogen BMP"—Comp��ance component�r,5 of 5 �Not app6cable
i�.�� � � ....
Is the system opera�ted under an Operatin9 permit? ❑Yes D No If•yes",A below is requlred
Is the s�rstem required to employ a tVitrogen BMP? ❑Yes ❑No tf"yes".B belaw ie�equired
BMP=&est Manegemant Pracaoe(s)spec�7reaf in the sysfem demign
If fNe answe�r to bo�fi ques�iwis is"no;�hls section daes not need Oo be comple�ed
Co�n liance c�teria -
a. Operadng Permit n�anber:
iiave the Pertnit uremer�s been met? ❑Yss ❑No
b. Is the uired ' 8MP ie �c! funclipni . Yes No
Any�no"answer�Lta�icates Nancompkanc�
tlpg�ade Requlren�aMs(Minn.SteC§7i5 5u7 An bmrYr�erX tlxea!fi Public f+eallh and s�lialY(!7�°NS)rnust be qpgraded�or itc we
�saav�'vwe�d wdhJfn l�n morMhs ofieaeipt of fhis na8ioe ar w�hin a sNorterpeiiod/frequ�►�sd bY loce!ord�.!f ihe aYsfem Is fsAlrlg to p�tect
grau�d wa�ar,the sysd9m must 6s up�raded,�BP�Boed.ar r�use dtaaan�riued w�Hin d�s 6r►es�qrei►ed bY laceel a�aGnr�!f ar�exiadi�p system
is�rot feAYnp 83 delFr�gd in/aN;andhas etle8st fw�D!(a�t Of design sa7 sepera�inn,d�an bhe syslam nsed rrot be r�yogradec�,r�qpsrred�plaoea�or
�ts erse�ioontkx�q��Y�or+�nen�ae�/s mor�sb�Ct. 7Als pror�ilbn does not apply ro sqsle,m�s in.sAa+eJand meas
WeO�raad Pra�n,4r�es,ar 8w�se Usad i�r�auiec6o»wvEh fooa�bererage.and Jodgfing�aa alefu7ed in faw.
www.pa.state.mn.us • 651-296-63QD • 800-667-3864 � 77Y 651-282-5332 or 80d-b57-3864 • Ava�abbe in altemative formats
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Crystal Bay, MN 553�3-0066 � � ON—SITE SEWA(;L TREAT�N7.'
r�`,� � INSPECTION REPORT
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Owner: ��i't"`� 1�� Address:
Permit #�'s: Datea: S�I�r9��Contractors: •
City ordinance number 1�p requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
The on-site sewage treptment system at the above address has been inspected and appears to fall into the category
checked below.
(This is ��an existing system [ 7 new construction)
SYSTEM CONFORMITY 1-3 :
1 "CODE SYSTEM"-A gystem which meets all the location, design, and construction standards of the current City
Codes, and r�4ch is operating satisfactorily by treating and disposing of the entire current sewage input
without disch8rging 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 Godes, but was installed according to the code in effect at the time of installation, and which
is operating,�atisfactorily by treating and disposing of the entire current sewege input without discharging
any pollutan�S into ground or surface waters.
3 "NON-CONFORMING 'SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any
system which� lnay or may not meet all the location, design, and construction standards of the current City
Codes and whieh is failing for any reason; and any system with less than 3 feet of unsaturated soil or sand
between the djstribution device and the limiting soil characteristics.
(The limiting'soil characteristic 1Xi has or [ ] has not been identified at this time. If the limiting soil
characteristn�a has not been identified, this classification may be subject to revision.)
TANK CONDITION (5-10):
inspection indicates:
5 Pu�out not needed ak this time.
Solids accumulation: Sn tanks indicates they should be punped out this year to help prevent future problems.
7 Solids accumulation 6n tanks is at a critical level. Yanks should be pumped out as soon as possible.
8 System is dischargimg to the surface. Tanks must be punped out within 48 hours to eliminate surface dischar�e.
9 lnspection risers m��sing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
tank at next planpout. If tanks have not been punped out within the last three years, they should be �xnped
out now.
10 Inspection pipe is lbcated directly over tank baffle (does not give accurate measurement of solids accunulation). `
If tanks have,mot been pimped out within the last three years, they should be punped out now.
DRAINFtELD CONDITION 11-
D nfietd inspection indi�Gates:
Drainfield is dry, rwd surfacing evident.
� Some evidence of sur�f�ecing, not critical yet.
13 Drainfield is satur�eited and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately. R�epeirs must be completed within 90 days.
14 Drainfield extent anp condition unkno►m.
LIMITING SITE FACTORS Cslo�e.setbacks.etc.):
POTENTIAL FOR SYSTEM FAILURE (decends on soils,water table.etc.): �,� �
COMMENTS:
Date of ,Inspection Se i System inspector
Note: In the event that thjs 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 opim on of the adequacy of the system under current conditions based on the available
informat�on.
This repoex must be kept on the precnises with the system locetion arid p�miping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
���
CITY OF OR0�0 O O
M�icipal Offices
Post Office Box �66
Crystal Bay, MN 55323-,0066 � � ON—SITB SEWA(�E TREA'1'l�I�iT
r�`, � INSPECTION REPORT
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Owner• � Addreas• � �
Permit �'s: Dates: �a[�/7 Contractors: , .
City ordinence number 10p1 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 category
checked below. �
(This is [ ] an existing system � new construction)
STSTEM CONFORMITY (1-3): '
1 "CODE SYSTEM"-A �ystem which meets all the location, design, and construction standards of the current City
Codes, and wh'I�h is operating satisfactorily by treating and disposing of the entire current sewage input
without dischp ging any pollutants into ground or surface waters.
2 "CONFORMING SYSTE�"-A system which does not meet alt the location, design, and construction standards of the
current City Cndes, but was installed according to the code in effect at the time of installation, and which
is operating �ptisfactorily by treating and disposing of the entire current sewage input without discharging
any pollutants into gro�d or surface waters.
3 "NOH-COMFORMING SYSTEM"-A prohibited system; a system located within e designated 700-year floodplain; any
system which mey or may not meet all the lxation, design, and construction standards of the current City
Codes end which is failing for any reason; and eny.system with less than 3 feet of unsaturated soil or sand
between the diStribution device and the limiting soil characteristics.
(The limitin�.$oil characteristic �1 has or [ ] has not been identified at this time. If the limiting soil
characterist�C has not been identifiied, this classification may be subject to revision.>
TANK CONDITION CS-10):
��
ye� inspection indicatest
l 5J Punpout not needed �V this time.
"S Solids accunulation 7n tanks indicetes they should be Fxniped out this year to help prevent future problems.
7 Solids accumutation i,n tanks is at a critical level. Tanks should be p�ped out as soon as possible.
8 System is dischargir� to the surface. Tanks must be punped out within 48 hours to eliminate surface dischar$e.
9 Inspection risers mis�sing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed �n each
tenk at next pqmpout. lf tanks have not been pumped out within the last three years, they should be punped
out now.
10 Inspection pipe is lpceted directly over tank baffle (does not give accurate measurement of solids accunulation>.
If tanks have riot been punped out within the last three years, they should be punped out now.
DRAINFIELD CONOITION (11-'k4)•
�field inspection indic�ates:
1 Drainfield is dry, no surfacing evident.
Some evidence of surf�cing, not critical yet.
13 Drainfield is seturated and visibly discharging untreated effluent to the surface. Contact the City lnspector
immediately. Rppeirs must be completed within 90 days.
14 Drainfield extent and condition �known.
LIMITING SITE FACTORS Cslo�,setbacks.etc J:
POTENTIAL FOR SYSTEM FA1LUg� (deaends on soils.water table.etc.): �J
COMMENTS: '
Date of; In pection p c System Inspector
Note: in the event that tbis inspection report is used to satisfy the requirements for a mortgage or other transfer of
property, be advised that tlhis report does not guarantee or certify that an existing system will continue to function
properlyi but is merely en opim on of the adequacy of the system �mder current conditions based on the available
�nformatton.
This report must be kept on the premises with the system locetion and punping records.
N►H�TE COPY/Inspectors File YELLOW COPY/Homeowner