|
Feb 0�13 09:10a ' Jos�ph Olson ' i 763-498-8290 p.4
<br /> 1
<br /> II ress: I'65 Stubbs Ba Ro No�th, arono,MN Inspector ini6als/Date: J.O.OT106113
<br /> lroperty a�i V
<br /> '�
<br /> 4. SQi I Sepd��fi01�—Compliance component#4 o�5
<br /> Date of inst�llati n: 9/23l96 ❑Unknawn Verification method(s):
<br /> Shorelardlwe!hesd probactlonlFood Beverage �Yes � Na Sal observation does not expire.Previous soi!
<br /> Lodeirrg� � . .observati�ns hy!wo indeperldent par�ies ane su�cient,
<br /> om Ii�nce crRe� 'a: �, ' �unless sfie conditions have been alter�sd orlocal
<br /> . requiremenfs differ.
<br /> For systems�juilt pri' r to April 1, 998,and ❑Yes ❑ Na
<br /> not�ocafed in iShore and or Wep ad � Conducted soil abseNation(s)(Attach boring bgs)
<br /> Pmtection an�a or n f servimg a , ❑ Two previous veri6cations(Attach bom�g bgs)
<br /> beverage orl�g estab!'rsbmeq�
<br /> ❑ Nat appliCable(Noldrng fank(s),no drainfie/d)
<br /> Drair�field has at lea t a two-foot y�ertical ❑ Unable to verify(See CommentsiExprsna�ron)
<br /> separation di�lance om periodic�Jly
<br /> saturated soil�r ck. � ❑ Other(See Comments/Explanation)
<br /> _ 1�►tpeiformartce syishems 8ui/�APnl t, �Yes ❑ No Commenis�xplanalion:
<br /> 96,or late�or forr�on-performance
<br /> sXsCsms located_ii�`�tft�?ef�iRi��r IfVeNhead "�?_��8-82�3 0 ".�:
<br /> P�tect�on A�as or serning a ,
<br /> b verege, orlodging establishm t:
<br /> J D�ainfreld has a three-toat verti
<br /> �_, � aiatiortdis��+c�sftAa� 6d' c, 1�.: -,--- ni6: � r::� e ,;. C'. C" '�"
<br /> . � _ __
<br /> , , i �p _._ _ . __ �_.._ � _ __ ---------------- __ ---- - . __.�--
<br /> saturated soil or bedrock.'`
<br /> •y��pe1fR'I18/F�' '�1 . "a�s�-�. , r Y ,� ,� ::� i � ;r,. fl;
<br /> �... ° � a�';- ptl�er';o�-...l�e aFlce" C�-Yes�—Q No.. ___._.. Indicate de ths-�f-ekwations- . _.. ._ __�
<br /> systems built Nnder pr�e-2008 Rli s;Type IV
<br /> . ,. __.
<br /> ��l�nt&�IJ?►�le�2d'b(�C��. �s_(7080. �.._l '..1����::-�� „���. A'.�.�Sottnmofdistr�b�iwr_ ia 94.1
<br /> "�.Q�r:ZO80:�pAAQ�Ad��,f��dor ,; ,
<br /> Licer�sere ui e , ��-, . � ;�+:: ,,� .,� _ � ,or. ,;p, ,
<br /> q f � 8. .Periadical salurated soi � rock �. , ' 91.1 �: -
<br /> �Dc��rnfield.crn:e��tb��signed vertical C, ;`S �tem se 'iation` r�:•,�;.•Ur�•� r,rr��-c,�3:0 ''
<br /> - se ration di�tance from�A riodicall�r _-- p: �eau � .
<br /> safurate��biPiit��i�'7t"�It�n1 � ��� ,., :,�: �
<br /> �, �� _ ired wmP.heRPe-saraa+�tpn :,� ,,2.6:, �� �,,
<br /> �
<br /> ,��yrr"t�o�:,�w#�'<abo,�e,i�tdicates the system rs �IVlay 6�e;reducad up�tml5�percent��f�aUaw�d 4y�Local
<br /> FtBilir► to R�'1DfieC�+`C3!'��iDWndw8fel: �Or inance.
<br /> 9 ..., � ., a�^ ,,:•�`:si,�r'rg;drl , �':, t'�., �.r,
<br /> �r�a;.i'3r , '�u<c ,at �...;;t� ;�AI,.; 9C1ctt��"rt�_ t �. . :�r:�:c; ��,i ,. f:xDv � �
<br /> .. �'�'tl , ' .. _ �
<br /> 5. (� �.�����'�$�i�`�1�Y'ogen 8MP"—Compliance com�wner�t#5 of 5 �������ld#appiicable
<br /> _ ___ ---_ ___ _
<br /> 'k I�+,�le����c�!'�1�€l;14+��r��O�:�atir�g PermE�?�� ;� �aYses ❑ NQr ,�f::"yes",�1rbe��►IAhis required
<br /> � q� r �'� 1 r t :;,. '
<br /> Is���sj�stem r,i�e�u�r�t�to,��lS�iy�j'�Ii►ragen BMP? ❑Yes ❑ No If"yes", B betow is c�equired
<br /> sy�,, :: ,.. f�. �E� .s1c�.e a � E�,rP,�.<a�
<br /> PrvBA�R�B�st+�anag��.qt��iacCce(s)specrfred in the system de�n
<br /> hevrr•-��,�-, i_r� ,"�^.�c:ni7 t:::t�ibl��:h� � „t
<br /> ff the answer to both questians is "no". this section does not need t�be completed.
<br /> 1:fbbi�7l�::r.. �.1:;ci�c! i�.'�(f-.;f...�'O�It bf.',t�9CS:
<br /> f t: � " t"11(; ;i;?ti(l�t,�;:ii{^.I'i
<br /> C� �� `nce'�iC� a � _
<br /> , . .. .. .
<br /> a. �Operatin�Permit number
<br /> __ _ _._._ _ _ ._ ---. __ ❑Yes ❑ No
<br /> ��...Hau 'O ati P rnvt ui eMs b�en met? �: , � ` ,;,�:.;��•r� �,
<br /> . . ,.
<br /> __._ _. ___ .- --. _
<br /> .6yst�is th��rfe e�"� ����I�IP'in 1 nd iunctionin , .
<br /> ? Yes ❑ No
<br /> � y.��,,�,, i,�, �, , ;. ,,,. � . , :,. : � ..�rr,eUF, __� _ _
<br /> A��'�`�n�':a�swter,inellicafes,Mooacornp/iance. - --
<br /> _�C.E"',,r ta �i,M:�rCl; C.' !- s:tli� �., ,,I�M+.,ar
<br /> �if8. ,1'!:'i:) . 'ti:t_- �',,C.:?SlC�fl(i a 4'r f' .'��: _ .. .,
<br /> U���R,4qu��M�(�lip�r;��¢;�i;i15.551 An imminent threat to pubfichealth�ndaa/efy(1TPH5j musFbe upgraded,ref�aoed;or-its u�se
<br /> ����wi�J�t��,�q��(rs of�ecelQt af this�wtice or wi�hin a shoiter perivd it requireal by l�oca/adirranoe.Jf the system is faiYng to protect
<br /> �� the systsm mvst.be upgraded,replaoed or its use�soontinved wiChin the tima requu�c6by°�1o�el oFdinence.ff en•�xis�ng syslem
<br /> is,�l�l��fB►�4S��S�1�.'�"�a����;�lwofe��of�esig�.�l4separa6bn, f,h t�hesystemneednotp� . rade�,. replaoed,,pr
<br /> r � d. �ylp�q!orrliner�ce diatis man sfr�ct.This iOFi dbes n�t af�O]}�`!o�ms'ln`s��,si8'as,"
<br /> ,
<br /> V�11��p�rr' , 6�9d ih`c'�nne�atian-witj►fooa�-bererage.and 1' ng establishments ss derined ln law.
<br /> ,$��i,,,,�.. : . .asRrti�i� �f:�'iT��d��fx4�P.3"!.:.mn-���.���Rl,A :t. �[�fi�l4ri1-71�.6'�i'Jnr'RA(1-6573864 L:Z=i'AV��lable�i�YBfEemativeformats
<br /> � „__. .�.
<br /> '� � _ _ .. . ..__.__.. _...
<br /> _._�...�. ._. ... _ .r...__. _.._...,_...._..�_. ._._._.. . __.__, .. ..__. .-.__, _._.. _. . __._ ..._.. ___.._ —.--
<br />
|