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..�,� �t � � .....�..a �����o�,,.� o�o�.�.,��..... ,�v-,..�-.�:, r., <br /> . . Parcei m�mber. _ yystem stazus: Q Corr�ant �]Noncornp6aai <br /> {as deteanined by this h�rm} <br /> Tank lateyrity�nd SafetY Canplia�ce -Comp(ianoe lnspection Fonn for Exi,sfiri�SSTS <br /> Cort�tiance [ssue#2 of�4 <br /> Date of observation: 912�10 Reascn For obseriation: �eQuest Fram;�oraeowner <br /> This form expires on(thres yrears}: 9/2113 � <br /> Corttpliance questionsicriteria:(Required3 Verificats�Methad•":(Opbor�t� <br /> Chsck�re ate box <br /> (Check fhe spprvprtale i�ox) <br /> C�s tlse sy�em cons+st ot a seeP�A�1`. L�Yss �No � Probed l�nk bottom <br /> o�l. ell or teachin it? <br /> � [ �bserved 1ow tiquir!tevel <br /> Do any sawage t�1c�s)leak below tt�eis �"j Yes No <br /> designed ape�g�nth? � � Exarnined constructian rxords <br /> !f yes,idenh7y v�ich � Examined emP�Y(P��d)tanic <br /> sewage#ank feaks. ❑ Arobe�ouside ta.^.k for•Mack soiP <br /> Any'�es'ansrirerindPeates tErat the sy►stett�is faU�qQ M profeet <br /> gr+ou»d svat�t. ❑ Pressurelvacuur7e Chec3c <br /> ' Seepage pi�meeting TLtE0.2550 may be compSant i#apowed � �� <br /> in arc�nance by loca[�erm;t4ng autherily. . <br /> "Nc�ard p►a'oco/exis�s.This lis�`is not axha:rsfive,�n <br /> sequeretia!order,nar dcss�`indicata wtr;e;h combinefi�s <br /> are rracessary to mske�is tieter:rt7nabcrr. <br /> �dfEf}/��i��C <br /> '!. Are rnaw�fies�ance hole cov�s darssa�{ect,cracksd.or ePPeared ia be slrucluraf?y unsound? �Yes` �No <br /> 2. We-s maaitenance hate covers replaced�a seared manner{e.g_.�rrws�l? �Yes p No• <br /> 3. V4as seconday�restr�r�presert tsa�eEy pan,secaid cover,or sau`eEy neitin5}–�i�hy�ecamrnended_ ❑Yes���]Na <br /> 4. A.•e oihar saf�ijr/l�Eaith issua,xesent? ❑Yes' �j No <br /> EX�7�81R: <br /> 'SS�em 1s atr Nnmin�t ihreai�o p�bl�c health and safe2y. <br /> CL'rtlf3Cd1'lCh <br /> This farm is to be cortr�lsted and attached Go the S:lmsnary Form af tt�e Minnesota PoEi�-tioa Cor�tr�ol Agency's(AAPCA)Comptiarx:e <br /> Uupeclion form for Exist#ng SubsurFace SewaQe Tre�atmer�t Systerns.Obsenrafions,'s�tsrprel�tians,�sd cond�sions must bs <br /> cemptet�d by an inspector.maintainar,or service provider.Campte�d form must be submitted to tiie ioca�u►rii o#�vem merrt witlsin <br /> 15 days <br /> Property awrser;rarne(s): 5cott and t�audia�Neis�erg <br /> �toperty address: 298t1 Sussex Road Lang take,MN b5358 <br /> PropGRy awne�'s address(�f d"rNerant): <br /> :.ouniy: H�rieP� Property o�met phone- 952-937 2967 <br /> !heree�y certify thaf J peisorTalty mede B�e o'vservaGons,irfterp�eta�on�,and cdnclusions►epo:ted on#his fv.�rn and that tt�ey are <br /> correct. <br /> Name: James Braeg�marsn Cer06cation rumber. <br /> Business ficettse name and number. ElmerJ.Peterson Co. License#219 � Qr <br /> Plama oi toca3 ''�t govemrr►ent <br /> Signature: ,. ba�: g/�•'10 <br /> � —�'_'�" <br /> www.p�.state.mn.us • 651-296-b#�D • 800-b3T-3g64 • M 55'.•282-5332 or 8G0-657-365� � fivailabte in aitemat�re formas <br /> wq-waviists4•31 . 412�lD9 <br /> A2ge 3 cf s <br />