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n lNan. H. 201 3;41 PMl'ei.erson o. ti a 763-972-7217No, 1307 P. 6/9
<br /> r `
<br /> Parcel number. System status: SConnplient ❑Noncompliant
<br /> (as determined by this folrn)
<br /> 6
<br /> Tarok Irate "ty and Safety Compliance— Compliance Inspection Form for Existing SSTS
<br /> Compliance Issue #2 of
<br /> Date of ob�56rvll�idh. 1I1$Itt ' Resot�for obsetvstioH': ' °Pant of Sale t' IJ ' i E r;
<br /> .6
<br /> This form mpo4vn.Mrrp,yyjrp } 11.'6116.
<br /> Compliance questions/criteria."(R quired) Verification Method":(Optional)
<br /> • Check file Awmidate box (Check the apprvpdate box)
<br /> Doesthe s consist a•seepage []Yes IN o ❑ Probed tank bottom
<br /> cesspool,d I or leach it?
<br /> Observed low liquid level
<br /> Do any sewage k(s�yte ittaf low1hairi ❑Yes'"1 o < 11, r l< :11'7 a t,), rii,r. i N 1'Y"tt1:4
<br /> desi ned er+ de th [T.Examined construction records
<br /> t �pt' 1 ,
<br /> �° ear; i�Ires,,Jdentdyr,rrbich, i Paterson o. ® Examin } d to
<br /> s wa�e'tank j
<br /> Any"yes".nawerfindtoates that the s is ftway to rotes! Probed outside tank for" (ask ail"
<br /> g P ElPressurelvecuum check
<br /> .�, ground water.
<br /> Seepage p14s meeting 7080.2550 may be compliant if allowed
<br /> 0 Other
<br /> in ori arca by local permitting authorty.
<br /> PHR: TI�fT1D�r
<br /> -- -_� fa"j LAOpOardprokcclRXO#. This fist is not exhaustive,in
<br /> sequential order,'nor does it ind/cete Which combinations
<br /> are rrecassary to make(his defenrlhin ion,
<br /> lllllwlc.#t ty and Safaty *t,, '.ancra — lnsfle °if:.' 'cr&lsting SSTS
<br /> 22L.o rl trz)t�kgl ,9 s4am d,cracked,or eppeered b be siructually unsound? ❑Yes" ®No
<br /> DeteWp��,main�once}��p ��.ppvers rept in.a s��red manner(e g. rrws )? ®Yes ❑No*
<br /> OT OpSE'Nfi`Fj�:il: TAT7�T�S 3.�85ol! :C1 741:.it.' a�r:.lrl•
<br /> -- —
<br /> �Itles seconder y q rest Int pr )rit.(sa[ety pan,second cover,or safety netyng)-highly recomms 6d—, Yes No
<br /> his urm Qxplre n i re years
<br /> 4. Are otlier sefetylhealth issue presen _ es W ho
<br /> Go � e ; ae+wt�aris e�ritem7: (F Eru,r,. VH�iii;.atitir: ths,;f•'; (Opticnal)
<br /> _ C�T"-N t ,a {Cha..is:ra Sox)
<br /> s an mm nen t rearto '551 �hea� as cry.
<br /> Does . , to n con,st nta seepape p �s r l�.
<br /> cesseco, drrrwelly of i aching it? _
<br /> [moi Cl w,�r: yr tiaaUid� level�I! Q�nk(si it-;rk}x)alEs�r It;rair �: . :s !!�NO ,ctw. r%
<br /> PCA)1 r a u` '
<br /> ars A n r c Rs ln�PCA)Compliance
<br /> d t the Sun�trs�dorm of the Minn o o ui,on ar gen s
<br /> R i"in for Exlsttng•, u,_ a Sewage Treatment Systems-Q�dnratidns,u�ter�(a drtbaWicluslons must be
<br /> 6fi # �arl. speclor, mein 'mer; `service provider.Completed form be submied to fi o pn' of pvernmenbvrithin
<br /> 15i1§`•ermwer Inc6c,.0as that the sy wn e: ,..: j'f1ji?to jrf'UjL� �1 r E3s 3cF,Jm ct)�ic
<br /> g unc Ovate).
<br /> Property owner name(s): Steven Her-
<br /> Ej
<br /> �i�i��8i'6se"e�BlliD?'�1e�+tblD -l�lapid F�ili,�ihl �59 __
<br /> or;finanre-b; r 16t73 pmrmfrong'000,01ty.
<br /> Pr9 `arty owner's address-(IF dltfnrwc:
<br /> County: Hennepin Property owner ph erG12.64t1-2Z6fte:it inelcete onco
<br /> drF rtt"Gf i.'5ti :G :"'Jife Wis detneq4,w(1 o!7•
<br /> i personally made the observations,�"taffons,and ponclusions reported on this lcm►and,that they are
<br /> caa,,A,.re
<br /> ` .
<br /> rnaLnfen-ance Ijole uvr'�,dar 1 d c;:✓ or^pP E� : ne�-trucsue�i,y �n,o1a, [�Yez" �; No
<br /> aer„Ja. es Brae (mann CertlNcpor�jnumber.-
<br /> are
<br /> uEur uy5' ec �{� �Spr mer J.Petesbn Co- Lice-, rase#11 - . -q;Q
<br /> mer .
<br /> r .
<br /> Va��rr�oMI,, e
<br /> Fa enrt.
<br /> Date; 1/1611
<br /> ' a 4r n, a r.•
<br /> �� -M 1.TTY 651-26Z-5332 or SOa657-38b4 Available in alternative formats
<br /> lscs4,31 4124109
<br /> _ Pose 3 of 8
<br /> r —64 AL •.+,a.... r
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