Laserfiche WebLink
_ 04/15/2010 11:58 7634988290 RUSTYS 'PERC TESTING PAGE 11 <br /> Parcel number. 0411723220032 System atat - ® Noncompliant <br /> Compliant ❑ <br /> (as detamilhod by this form) <br /> Tank integrity and safety ConIIP11antae <br /> Compliance Issue #2 of 4 <br /> Date of observation: 4112/10 Reason for observation:- pmwmt Transfer <br /> This form expires on(three years): 4/12/13 <br /> cc mpliancs questionslcriteds: (Required) Vwftatton Method": (Optionan <br /> Check Nre appModate box) (Check the appropriate box) <br /> Does the system consist or a seepage pit', ❑Yes ®No ❑ Probed tank bottom <br /> cess l d I,or leaching . <br /> ❑ Observed klwr liquid level <br /> Do any sewage tanks)Wak below their ❑Yes ®No <br /> deft Heol operating depth! ® Examined construction records <br /> If yes,identify which sewage [3 Examined empty(Pumped)tank <br /> tank leaks. ❑ Probed outelde tank for'blaclk soil" <br /> Any'fires°answer kxft les shat the system Is fORM9 to MOW! [] Pressurs/vacuum check <br /> ground waft: <br /> ❑ Other. Peterson Comm <br /> + Seepage pits meeting 7080.2650 may be compliant if allowed <br /> in ordinance by local permitting authority- <br /> "Wostandard protocol exists. This list is net etrheuaMre,in <br /> sequendal order,nor does#indicate>>wNatr oombinadons <br /> ere necessary to make this determination. <br /> Safety Check <br /> 1. Are any maintenance hole covers damaged,cracked,or appeared to be structurally unsound? ❑Yes• ® No <br /> str <br /> 2. Were all maintenance hole coven replaced in a secured manner(e.g.,all scam replaced)? ®Yes ❑Now <br /> 3. Was secondary accuse restraint present(safety pan,second cover,or safety netting)-highly recommended. ❑Yes ®No <br /> 4. Was any other safetylheaRh lacus present? ❑yes- ®No <br /> Explain: <br /> 'Systtam is an immkw d&,rest to pubNc hosle and satiety: <br /> Certification <br /> This form is to be completed and attached to the Summary Form of the Wrinsiota Pollution Control Agency's(MPGA)Compliance <br /> InepwAon Form for Exldtinp Subsurraw Swoops Trombnod Systems.Observations,Interpretations,and conclusions must be <br /> completed by an inspector,maintainer,or service provider:Completed form must be submitted to the local unit of government within <br /> 15 days. <br /> Properly owner nome(s): Baker Homes Inc. <br /> Properly address: 6 Watertown Road. rnrw MN 56356 <br /> Property ownses address(if ditferent): <br /> County: Hennepin Phone: 651-276-0413 <br /> 1 hereby certify that/personally made the observations,interpretations, and Wnduaions repotted on this form and that they are <br /> cornea. <br /> Name: Joseph/.Olson Cartytion nurriber: 1255 <br /> Business license name and number: Rusly Olson's soll and perculotion testln9 l.fa S 810 or <br /> Nemo of local un of govemmen• Orono <br /> Signature: Date: 4/14/10 <br /> wq-wwlsts431 Compliance inspection Form for Existing SSTS <br /> 414108 <br />