Laserfiche WebLink
06/29I2066 23:19 7634988290 RUSTVS PERC TESTING PAGE 03 <br /> 1/29/02 Water/Wastewater-ISTS4.31 <br /> Compllance Inspectio� Fornn far Existing <br /> Individual Sewage Treatment S�stems Mlnne�vta Pofludon <br /> Conb�ol Agency <br /> CanA/eNon of this form fuNPps the mdnlmal�qu/rementa o�Minn. Stat. § 115.55(2001 J and Minnesote R. ch. 7080(1999). Prease <br /> rete�to/ocel oidinences ff�r od►er�equl�ements or infr�rma6on,aspeclaily for compliance�epuirements f�r bedmom addiKons. <br /> w <br /> �.116�iia l I <br /> Dabe of Inspection: OG/28/06 REASON for inspeclJon: �rooertv Transfer <br /> Properly Owner(s) Teleplwne ( ) <br /> Person requestinq inspectlon: Ed�M�►hran Telepha�e (612) 810-3745 <br /> S16e Address: 3150 Su�c�q$d Clty: �rono Zip Code 55356 <br /> Fire No./ Paroel No. Cau�y: H�neoln TO�wnshlp: <br /> Lepsl Despipaon <br /> Local Reyul�bory Authoritfl:�,y of Orono <br /> Date sys�em oonstrvtbed: �/15102 Stirs�em in Shoreland Aroa: yes no S�sbem in Wellhead <br /> Protection Ar+ea: yes no S�m serviny a MDH lioensdr!fadiily: yes no Loeal Perntit# (if any)� <br /> S�rs�ems built prior tp Ap�l 1, 1996 a�d not locabed In Systems located in Shereland or Wellhead Pro�tfon <br /> Shoneland or Wellhead Prot�ct9on Anea or Serving a Food, Areas or Serving a Food, Bev�erage or Lndging <br /> Beverage or ladging Establlshment Establishment, or systems Buiit afber <br /> March 31 1996 <br /> ls the srs�em an Imminrrrt tfir+e�a�t b��ublic healtl�or <br /> �(a y�s ansr+�r�r an ITJ�Yi�S sys��m) or�af ieetv� (a yes an�ssw�r is an.I7PH5 syst�+n) <br /> -Disd�arge of sewege to tt�e grou�d surtdoe? YES NO - Discharge of sewage to tl�e ground surtaae7 YES <br /> -Disd�arge of sewage bo draintile or surfaae wat+ers? YES NO -Discharge of sewage to diaintile or surfaoe watet5?YES <br /> -Sewage badaup Into dwelling� YES NO -Sewage backup InCo dwelling� YES <br /> -Sibuation wRt�the pobe�bal tn Immedlabefy and -Sit.uatlon with the paten�l to ImrrrediaDely and <br /> ad�,,eiy impact or threaCen public heatth or adversely Impact or threaben public health or � <br /> safiety7 YES NO 5afety? YES N <br /> Is fite�vsst��am failina? (a y�s answ�r ls a faI/!ng system) �tlte svstem !°alllna? (a y�s ansvr�r/s a Failing syst�mJ <br /> -Less lt�n TVYO feet of vertial 9ep�aradon bc�ween - Less tfian THREE feet of verUtal separation between <br /> sy�bern bottom anG saburated soil or bedrock? YES NO syst�em bottom and saturated soll or bedrock� Y <br /> -A 5eepage pit,oesspool,drywell,or leathing plt? YES NO -A 5eepdge plt,oesspool,drywell, or leaching pit? Y <br /> Is tlre svetem non-comnliant? ��,��y�p!�an-comMiant? <br /> - Is tfie system regulated under a monftoring plan or - Is the system regulated under a monito�ing pla <br /> ope�ating permit'� (�no, go to page 2) YES NO operating pertnit? ("rfno, goo to pege 2) Y NO <br /> 1!yes, If yes, <br /> -Has the�equire� monitoring taken place? YES NO -Has the required monitoring taken place7 YES NO <br /> (If no, fhe system is non-complying) (If no, the system is nor�-complying) <br /> -The monitori�g indicate that the system meets -The monitoring indicate that the system meets <br /> performance expectations? YES NO perFormance eXpectations? YE5 NO <br /> �rr�o, the system is non-compJyingJ (l1 no, the aystem is non�anplying) <br /> Page 1 of 2 wq-wwists4.31 <br />