Laserfiche WebLink
Property address: 2500 SIXTH AVE N Inspector initials/Date: CB � 4/13I2015 <br /> (mm/dd/yyyy) <br /> 1. Impact on Public Health—Compliance component#1 of 5 <br /> Com liance criteria: Verification method(s): <br /> System discharges sewage to the ❑Yes �No �Searched for su�face outlet <br /> round surface. �Searched for seeping in yard/backup in home <br /> System discharges sewage to drain ❑Yes �No �Excessive ponding in soil system/D-boxes <br /> tile or surface waters. <br /> ❑Homeowner testimony(See CommentsiExplanation) <br /> System causes sewage backup into ❑Yes �No ❑"Black soil"above soil dispersal system <br /> dwelling or establishment. <br /> ❑System requires"emergency"pumping <br /> Any"yes"answer above indicates the ❑Performed dye test <br /> system is an imminent threat to public ❑Unable to verify(See Comments/Explanation) <br /> health and safety. <br /> ❑Other methods not listed(See Comments/Exp/anation) <br /> Comments/Explanation: <br /> No seeping or backup,no excessive ponding in soil system. <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Cam liance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑Yes �No �Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. <br /> ❑Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑Examined Tank Integrity Form(Attach) <br /> com tiant if allowed in local ordinance. <br /> �Observed liquid level below operating depth <br /> Sewage tank(s)leak below their ❑Yes � No <br /> designed operating depth. ❑ Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil" <br /> Any"yes"answer above Indicates the ❑Unable to verify(See Comments/Explanation) <br /> system is failing to protect groundwater. ❑Other methods not listed(See Comments/Explanation) <br /> Comments/Explanation: <br /> Liquid level was at opera6ng depth. <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenance hole�vers are damaged,cracked,unsecured,or appear to be structurally unsound. ❑Yes* �No ❑Unkrrown <br /> b. Other issues(elecbical hazards,etc.)to immediately and adversely impact public healtfi or safety. ❑Yes* �No ❑Unknown <br /> "System!s an Imminent threai to public hea/th and safery. <br /> Explain: <br /> c. System is non-protective of ground water for other conditians as determined by inspector. ❑Yes' �No <br /> "System!s talUng 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 • Availabte in alternative formats <br /> wq-wwlsts4-3t • 3/16/12 Page 2 of 3 <br />