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Mar 21 12 p4: p 763-213-0695 p.2 <br /> i. <br /> y • I <br /> Qro ress: O ` lnspector ir�itialslDate: —� '(� � <br /> 1. Imp ct on Pubtic Health—Compliance oorr�ponent#1 of 5 <br /> liance criteria: Verification method(s�: <br /> discharge sewage to ihe �Yes (� No � Searched for surface oudet <br /> ou surface. � Searched for seeping in yardlbackup in home <br /> ys discharge sewage t�drain ble ❑Yes �No � ��ss�ve ponding in sol systerND-boxes <br /> � ��t�. � Homeowner testimony(See Gbmments/ficplanetiorr) <br /> "Bladc soiP above soil disper5al system <br /> ys cause sew�e backup irrto ❑Yes � No ❑ gystem�equires`emergency'pumping <br /> d II g or establisfimerrt. <br /> ❑ Perfortned dy�e test <br /> ny'yes"answer above Indicates d�e system is ❑ Unable to�eri�y(See Commenfs/Explanation) <br /> n/ minent Threat to Public Health and Safety. ❑ p�er methods not listed(see commencs�c�anation� <br /> C�om ents/Exp(anation: <br /> 2. l�an Integrlty—Compliance componerrt#2 of 5 <br /> C liance criteria: Verification method(s): <br /> 54 consists of a seepage pit, ❑Yes �No I� Probed lantc(s}bottom <br /> dess I,drywell,or ieaching pit. � Examined oonstruction re�cords <br /> S�ee pits meating 7a80.2550mey be � Examined Tan[c Ir�tegrily Form(Attach) <br /> nt if al/awed in loca!au'iaar�e. <br /> � Observed liquid level below�perarting depth <br /> e tank(s) leak below iheir �Yes �J No ❑ Examined em ' <br /> d si d eratin de pty(pumped)tanks(s) <br /> ye ich sewage tank(s)leaks: ❑ Probed outside tar�k(s)for"black sal" <br /> n yes"answer above in�cates the ❑ Unable to verity(See Camments/Ezp/anation) <br /> ys is Fail�ng to Protect G�oundwater. ��er methods not listed(SeeCommentslExplanation) <br /> dom MsJE�►lanation: <br /> 3. C�th Cornpliance Condifiions—Compliance cornponent#3 of 5 <br /> . ' M rrtenance hole covers are damaged,cxacked,unsewred,or appear to struduraly unsound. p Yes" I�1 No p Unknown <br /> , er issues(e�ecbica!h�ard�etc.)to immedia�teiy and adve�sely impact public health or safeiy. ❑Yes* �No p Unknawn <br /> m is an imminent thr+eiat�p�rblk heallfh and safety ,. <br /> ' lain: <br /> S is non-protectivc of ground waba�or other conditions as detamined by inspector ❑Yos• �tro <br /> is fiiling�o pr�tectgroundMrat�er • <br /> lain: <br /> www. .mn.us • 651•296-6300 • 800-657-3664 • TTY 651-282-5332 or 8D0-657-3864 • Avallable in alternative formats <br />