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Ju1051210;15p Joseph Olson 763-498-8290 p.6 <br /> Prope�ty address: v"05 Stubbs 8a �Rd. id �� <br /> —�---. ^_.._ _ tnspector inipaislDat�e: i/71f2 <br /> 1. lmpact on Public Heaith—Compiiance component#� of 3 <br /> Gompl�anc�criteria: Ve '�'iication method(s): <br /> System disct�arge sewage to the ( ❑Yes ❑IYo ❑ 5earched for surface outfet <br /> _ground surtaca _ I Q Searched for seeping in yard/backup In home <br /> � ❑ �Q ❑ Exce,ssive pondng in soil systiesn/p.boxes <br /> System di�charge sewege to drain tile ; ❑Yes <br /> or surface waters. _, �_ _ ❑ Hameowner testi�ony(See comment�/E�cpranat;oa) <br /> S s�eri't ce€use sEwa e traCku r� ❑ "g1�k soil'above soil cfispersai system <br /> Y 9 P' •' D�es [� iVo <br /> i ❑ System requires'emergency"�ump�ng <br /> dwetline or establishment. , <br /> ❑ Performed dye iest <br /> �4ny"yas"artswer above indicates the system is ❑ Unsble to veriiy(See Cornments�zp/enation) <br /> an fmmfne»t Threat tn Publfc Healfh and Safety. C p�r methods not listed(see commen�xyana�on) <br /> CommentslExpla nation: <br /> Z. Tank Integrity—cor�►pliance componer�#z o�5 <br /> Compliance crrteria_.._._ , Verification met�od(s): <br /> System Corssists of a seepage pik � ❑ Yes � No ❑ Probed tank{s)bottom <br /> cesspool,drywe�l,or leaching pik I ❑ Examined construcdon records <br /> Seepage pi(smeetJng 7080.2550 may rie � ❑ Examined Ta��C Irttegrity Form[A1EacA) <br /> comA!lent ff eUowed in loce!ordu+anoe. � <br /> ❑ Observed liquid Isvel below operating depth <br /> Sewage tank(s)leak betov�their i ❑Yes �No � �mined empty(pumped)tanks�s) <br /> �esignad operaEing dePth- � <br /> If yes,�nrhich se�vage tank(s)IEaks: ❑ probed outside tank(s)for"black sal° <br /> Q �nableto veiiiy r3ae Commenisl�cplanation) <br /> Any"yas"ans�rer above irrdlca�es the <br /> syste�rr is FBilJng to Profecr Gmundwater. � �her rrrethods not Tistsd(ses CommenrsiFxp/arra�on) <br /> Cornments/Explanation: <br /> On 7laJ92,Efiner J.Peterson Co.uncoveted 2"d manhole(8"deep)and pumped septic i�anks. There is no pump in liit station. <br /> In orcer for syster�i to lunc�ion pcoperty,ihere needs to be a pum�insbalfed. <br /> 3. Other Compliance Gor�ditions—CompTiance component#3 of 5 � <br /> a. MairYtenance hole carers are damaged,craciced,unsecured,or app�r to structuratly unsound. Cf Yes' �t�Jo ❑Unkna�m <br /> tr. Otl�er issuPs(electr,'ca!hazard�,eia)to imnediately and�dverseiy impact public health or safety_ ❑Yes' p I�o fl Unknown <br /> 'System is an imminent threar to pubfie h�fth and salety <br /> E�ain: <br /> a System is non-profective af ground v►�ster for qther condi�ons as determined by insp�tor O Yes• �No <br /> �5y/st8m Ts fa�!!ng to pratecf grous�alwaiier <br /> F�calain: <br /> www.pca.stato.rm�.us • 657-Z96-5300 • 800-65738b? - TTY 651•282-533Z or 8001r57-3fi64 • Available in alternative fiomiets <br /> wq-wwistz-f•31 • 1/I�/12 Paqe 2 of 3 <br />