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<br /> -ctl f 1 `,/' � � ,t• � � ' is 1 _ .� r
<br /> y II rr .LSIIs � :.
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<br /> f J 5,:: i.. _ :s ..' .: . :�I�r E a�,:•!a inelu c: Vt'cll,well setback to system,dwellil g or other establishment,tank(s).Buil tIFC-10 ent systrm,
<br /> ,�,�„-,i ,,,;. .•, ,f t; ,1.:.re ,c Jr!un 1, f: .prol.ulry liucs waterwuys,and buried lines(hose NOT Installed by the utilityj. Inelu,ie si�cs and
<br /> 11XLd reh:rcncc points such as streets and built)' gs.
<br /> �1 �,t,+I L• : ; !t, ,, l,t rvun. lndie.tte the teXlllre,structure,color,depth of •aeh.differcnt soil I)i,:,evideuec 01'11-1,41114 bed,oa.
<br /> (,d rife m.tcrial is fill. Lucite each boring on attached sit sketch.
<br /> t,l'th:local ordinance that are differen�a the ate eq�9�Qnts ref 'cd to Illi" G�
<br /> 6y.'.0107 .P,��►Syr r:;ao�`' ''
<br /> I
<br /> A. hcfcl:�
<br /> 1;c wa' tie ttment systerIN true.:_',urate,wl u"I'll Acte.
<br /> I .:'ufy tt,; ail the utluf nl,,�io� I h:.ve p'ovidetl t�;.arding rile ina►Ka{lul. ii )')ate
<br /> t� -
<br /> Propel:; _ . .
<br /> state of l linnes.,ta licensed lnspectar and/or Designer 1 y{,Qualifi Employe})nsl)ector and/or Qu"Oled 1`010 )fie
<br /> L;,:,,• ,, , I :If;a 1 ct,nducted an imesugatiun In accardans with date. No determinationcable reqUirements lof future hural'ydraulic:tperfurm.incc'has lbeen Dur&ytntbhis
<br /> that my obs recorded are accurate udc
<br /> as of this
<br /> },,,tttl,;lyco cunEli[ions,luring system construction,abuse of the system,illi equate muintenance,'orr fUILIre water usa;,t�.
<br /> ( )_._ Phone
<br /> In�li:aur U:ui,: p''lllt
<br /> Lir:u e an.t't,: k:giSUataou Numbcr._r____--
<br /> Address
<br /> -ess�0
<br /> ;t•rna' to turtiljheujih or sa etv us defined at Minn. R.iUSUAU2(1 subp.'It):►,before
<br /> -
<br /> iii. 1,+'.
<br /> / rade Requirements
<br /> U.t,�tt:s 4 115.55
<br /> (,,law") Upgrade
<br /> Do
<br /> An ru.r[,., ..:rh :+,t l;..rr;,.u. and,ulverz-JY attert hi iJreaten pL,s7 tc 1 lic 01,SWrioU o/fit Tie ir�luyulreld by,)CUI l dr,c placed, or
<br /> IR:�:N(/i:.'.- i v.'rli:.•I r4. 7 111 ; !t c iJ}::Jl tli,S r1lillCC Or Wlt
<br /> 11O(1 Ciar!?;e �,s[t n i;u:�adol:[ed ari v: ':fltlnca contuining al[ernattve l6ciii stun( Wgs, the
<br /> Cd, OI
<br /> CIOes.901 C�ftirly + Ili, ?Jit'. O(dlrlalrCt:', 1[nlu5t Do t.ppluflE'd, rdj)li1'
<br /> J!J �':, , , Nil ,r'u�J, .1 It
<br /> t uxlst s:rnd the loc,,l unit a!jC,v /1:, +:nt with�4tli'Wi !lull cvE.v.
<br /> ,''•��[dln I$ tc�lltl�'.�c nd..'rlust�li Upj/"utJ'd, .l.placid, Or It:• i.JL discord l„tl:'d YNllhl// [Jltl tlllle
<br /> 1-,ilS!J p(Uv,J�cult clellt glou(Idwiltv;r prC)lGCtiJn, than the local rU1L'Or h h1 C'at IOldlna/1Gd uJ�;' I u;l C1 fur[ham!ill,'Sy�tc rn
<br /> tit•l+NJ1JU�.1 lrplJCcd, of its use discontinued within the oma requ •
<br /> llvud 110t be
<br /> is not)oiling as dalined in inu turd has at al-ld t two Lf''ol,od rd tianceli soil Sep
<br /> that isJmore stlict. This doers riot tppty to
<br /> uNJr ,a�tJ, , ,,airaJ, (E:M"Ced, or its use discontrnued, natwithstanding ar y
<br /> d i
<br /> wellhead protection areas, or those use connec on With food, beverage, and lodging estatilihrnEllts
<br />
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