Laserfiche WebLink
10/2912010 11:29 7634988290 RUSTYS PERC TESTING PAGE 05 <br /> Parcel number: 26-11&23-41-0009 Sysbsm status: ®Compliant ❑Noncompliant <br /> (as deftwWned by this fwm) <br /> 8011 Separation C0mpllanae and Other Complignae <br /> Compliance Issue#t3 of 4 <br /> Date Of observation: 10/19M 0 Reason for observation: transw <br /> Tft/nlbmwi on on M&farm does not expire. <br /> Compliance quest ionelcrNerle: (Required) Verification Method": (Optional) <br /> Check ills " fe box (Check the apprcpdate box) <br /> For systems built prior to April 1,1988,and not <br /> located in Shoreland or Wellhead Protection ® Conducted soil observation(s)(attach boring logs) <br /> Area or not serving a food,beverage or ❑ Two previous verifications(attach boring logs) <br /> lodging establishment: <br /> Does the system have at least a Iwo-foot <br /> vertical separation distance from periodically <br /> saturated sea or bedrock? Yes 0 NO <br /> For rWrFperfonmarm syowm built April 1, <br /> 1996,or later or for non-parlbrrnanos systems <br /> located in Shoreland.or WeW*ad Protection Sol observation does not expire.Previous observations <br /> Arm <br /> establishment:serving a food, or looming by bw InCIe conditions hwe et parties am suticient,unless site <br /> Does the system have a three-foot vertical <br /> separation distance from psriodicelly wturated <br /> soil or bedrock?' Yea No <br /> For reduced separation distance systems <br /> "perfoMWV6'systems under old 7080.0179 or ' INey be reduced by up to 15 percent If allowed In local <br /> Type IV or V system under new 7090.2350 or ordinance. <br /> 70902400): "No atandard prot000/exists. This list is not exhauaw, <br /> Does the system meet the designed vertical m sequerfel order,nor does it ffAwle which <br /> soil distance frote►m Psaturated com4inadians are necessary to make bYs <br /> Yes No debsmnation. <br /> Any"no"ansrwr N►dos[as that tlrs sywwn is firtlfng fo prmbvat <br /> gorowld wNw. <br /> Certification <br /> This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance <br /> Inspactlon Form For ExIoUng Subsurface Sewage Treatment Systems.Observations,Interpretations,and conclusions must be <br /> completed by on inspector or designer.Completed form must be submitted to the ball unit of government vAthln 15 days. <br /> Property owner name(s): Richard Seitz <br /> Property address: 1195 Wyndmere Road <br /> Property owner's address(rt dilrsrsr4): <br /> Cly: Henn"n Phone: 952.545-1005 <br /> 1 hereby cer*that 1 personally made the observations,Intetpretaftm,and concluaions tgxxted on Mls farm and that they are <br /> onnect <br /> Name: Joseph J.Olson Certification number. 1255 <br /> Business license name and number: Rusty Ohmn's soil and RL=Iationtesting 910 or <br /> Name of local unit of <br /> Signature: Date: 10/23/10 <br /> wq-wwtsw-31 Compliance Inspection Form for Existing SSTS <br /> 414108 <br />