Laserfiche WebLink
• <br /> • Property address: 165 Cristofori Circle Inspector initials/Date: 5/14/18 <br /> • <br /> 1. Impact on Public Health-Compliance component#1 of 5 <br /> Compliance criteria: Verification method(s): <br /> System discharge sewage to the 0 Yes ❑No 0 Searched for surface outlet <br /> Around surface. _ 0 Searched for seeping in yard/backup in home <br /> System discharge sewage to drain tile ❑Yes ❑No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. 0 Homeowner testimony(See Comments/Explanation) <br /> System cause sewage backup into 0 Yes 0 No 0 Black soli above soil dispersal system <br /> dwelling or establishment. 0 System requires'emergency"pumping <br /> 0 Performed dye test <br /> Any"yes"answer above Indicates the system Is 0 Unable to verify(See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. 0 Other methods not listed(See Comments/Explanation) <br /> Comments/Explanation: <br /> 2. Tank Integrity-Compliance component#2 of 5 <br /> Compliance criteria: Verification method(s): <br /> System consists of a seepage pit, 0 Yes ®No 0 Probed tank(s)bottom <br /> cesspool,drywall,or leaching pit. 0 Examined construction records <br /> Seepage pits meeting 7080.2550 maybe 0 Examined Tank Integrity Form(Attach) <br /> compliant it allowed in local ordinance. <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s)leak below their 0 Yes ®No <br /> designed operating depth. ® Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: 0 Probed outside tank(s)for"black soil" <br /> _---- _--- 0 Unable to verify(See Comments/Explenation) <br /> Any"yes"answer above indicates the <br /> system is Failing to Protect Groundwater. 0 Other methods not listed(See Comments/Expianation) <br /> Comments/Explanation: <br /> On 5/14/18,Elmer J.Peterson Co.pumped tanks. <br /> 3. Other Compliance Conditions-Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes' ❑No 0 Unknown <br /> b. Other issues(electnoal hazards,etc.)to immediately and adversely impact pub&c health or safety. ❑Yes' ❑No ❑Unknown <br /> System is an imminent threat to public health and safety <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector ❑Yes" ❑No <br /> "System is failing to protect groundwater <br /> Explain: <br /> www.pca.state.mn.us • 651.296.6300 • 800-657-3864 • TTY 651.282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4.31 • 1/24/12 <br /> Page 2 of 3 <br />