Laserfiche WebLink
Pancel number: System gtatus; ❑Compiiar�f ❑Noncompliant <br /> (as de(errnitted by this�otm) <br /> Ta�k Integnity and Ssfety Compliance- Compliance Inspection Form for Existing SSTS <br /> Compl9ance Issue#2 of 4 <br /> Date of obaervation; 8/3115 Reason for observation: <br /> 7his form expires on{three years): 8/3/18 <br /> Complianas questionslcrite�a:{Required) Verlffcatlon Metttod"':(Optionaq <br /> Chedc Hte riate box (Check the&pA►+�riate box) <br /> Does the system cbnsist o#a seepage pit', ❑Yes �No � probed tank bottom <br /> cesspool,dnrrvell.or leechin 't? <br /> Do any sewage tank{s)leak below their ❑Yes �Na � �����iquid�evel <br /> desi ned o tin d ? ❑ Facamir�ed co�struction reoords <br /> If yes,irleMify which ■ Examined emply(pumped)tank <br /> sewsge tank leaks. <br /> Any�res"answoarindfcaies that the syr$�em!s falthig�prol�ect ❑ Probed outside tank for"black soil" <br /> ground wa�er. ❑ Pressure/vacuum chedc <br /> p O�er: <br /> * Seepage pits meeting 7080.2550 may be oompliant if albwed <br /> in ordinance by loca!permilting auth�ity. <br /> "No�aaderd p�fvcol exisfs. This!!st Is»ot exAaasfiMe,in <br /> ss�ue»tia!order,nor does if indfcate whiah can6iaaGPons <br /> ar+a necessary!n make this determ�netlon. <br /> Safety Check <br /> 3. Are main6eitance hde oovers damag�,cradced,or appeared to be stNcturally unsound? ❑Yes: j�No <br /> 2. Were mai�enanoe hote oovers replaced in a aecured manner(e.g.,screws replacedj? �Yea ❑No" <br /> 3. Was seoondary axess re�iraint present(safetY l�an,seoo�oarer,ar safeiyr netting}—highly reoorrunended. ❑Yss �Plo <br /> 4. Are o�i�er satetyfiealth issue present? ❑Yes• �No <br /> Explain: <br /> '`System fs an Immiae»t dtreat tc�u6/k heslth and safeqr. ^ <br /> Certification <br /> 7hEs fom�is to be compEeted and attad�ed to fihe Summary Form of the Minnesote Aoliution Cor�trof Agency's(MPCA)Compilancs <br /> lnspectlon Form for Existing Subs�uface SeMrape Trsabnent Sysbems.Obsstvatbns,iMerpretations,and oonclusia►s must be <br /> completed by an inspector,malMainer,or servtce pravtder.Completed fi�m�must be submi�ed to the locaf unit of govemmant wifhin <br /> 18 days. <br /> Proparty owner name(s): Joe Lahti <br /> Property address: 2975 Someraet Lane Long Lake,MN 55356 (Orono) <br /> ProPerty owne�'s address(Ef dll�eren�: <br /> Courriy. Flennepin Property owner phone: 612-723-10�9 <br /> l her�by certify fhat!persflnally rrrade the vbserva�on�inferprt�i�tlons,and c�cnclusions nepor(�d on this form arnl that ihey are <br /> c.brrect. <br /> Name: James Braegelmann CeR'�'ic�tion number: <br /> Busineas livense name and number: ���►�er J•Peterson Co. Ucense#219 or <br /> Name af I govsmment: <br /> Stgnatvre: pa�; 8/31t5 <br /> www.pca.staie.mn.us • 651-246-63Q0 • 800-657-3864 . T1Y 651-282-5332 or 800-657-3864 • Avaitabte in alt�emative fortnats <br /> wq-wwlsts4-3t • 4/2�f/04 <br /> Aage 3 of 8 <br />