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Property address: 125TndFaia Trail <br /> --___-- Inspectoriniliablpate: 11/8/17 <br /> 1. Impact on Public Health—CompUence component a1 of 5 <br /> Com0agnce criteria• V <br /> System discharge&swage to the _ erSear ice or surface C <br /> _9ro1md surface. ❑Y� 6—W ❑ Seerdmed for surface 0tltlat <br /> ❑ Searched for saepinp in yam up,home <br /> System discharge sewage to t go ❑yes ❑No Q Exoss&ive ponding h soil systerNp-boxes <br /> or surl8ce waters ❑ Homeowner fteurrony Ma,CQMmnMeWWWor,) <br /> wap <br /> Th <br /> dikVSws em este s ishrrm b up into ❑Yes Q No a oleo"&8 oll W W system <br /> ❑ Performed dye System � <br /> an immipPinO <br /> �Y"Y'es"arrawwebow Q unable to <br /> imminent Throat to Public s �(S»awnmenra&pw s,n) <br /> -- ❑ Other methods not Hued(am <br /> Cor► Exptanaticn: Corxna+ldExplru6on) <br /> 2. Tank Integrity—Corrlpilanoe component a2 of 5 <br /> Novice criteria: <br /> System consists of a seepage Pit es o Q probed tank()fie): <br /> botlom <br /> ""Pool,drywall,orb aft Pit. ❑ Examined &wrrucNomm <br /> m=*Pse a 70e0.266omeY be m <br /> Yafbwed to bed ondh&ncs. 13EXamined T"Integrity Foran(Asad,) <br /> Sewage tank(&)leak below their 13 Yes ®No ❑ Observed lipoid level below operating depth <br /> designed operating death ® Examined empty(pumped)tanks(,) <br /> If yes,which,swage tW*(s)looks: —— ❑ Probed outside tar*($)for-black so r <br /> Any O.Vw answer above indkatag ante ❑ unable to verify(See <br /> sYatem is Failing to Pr)tact Groundwater ❑Otho mods not listed(Sae Co nmenieso emwr) <br /> CommsWExplenallon: <br /> On 1118117,Elmer J.Peterson Co.pumped tank,. <br /> 3. Other Compliance Conditions-COMPUarua <br /> component ll`•3 of 5 <br /> a. Maintenance hole covers aro damaged.cracked,uneemsed,or appear 10 struduraly unsound ❑Yee ❑No ❑ljrk n <br /> b. Older*owres fatrctrinlbaaatie Oft)10 immediately and sovaresly hmpa;t public health or <br /> 'Sysranr k an hrasfnant blrpt sp pub6lc haftlr and �y ❑Yes` ❑No ❑tJtYnrrovwn <br /> Explain: <br /> c. System to nonIN06 diw of 9mund water for other mrgYans as determined by i ❑Yes' []NO <br /> `SYS+b fis>OW fn f>oftcf <br /> Explain: <br /> •Pxe.staoe.mn.us . 651-296-6300 . 600-657-3864 TTY 661-2112-5332 or&00457.3864 -- <br /> w4-wwNats4-3f . 11241 f2 Avasable to&tterrutive formats <br /> P"e 2 013 <br />