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� Propgrtyaddress: 2�9�0 �u�,�a.os.L �,�tt� . Inspec�oriniUals/Data �,i��-�-ltlr <br /> 1. Impact an Pub[1c Health—Compllance companer�#1 of 5 <br /> � Com Ilance criteNa: Yeriflcatlon method(ffij: <br /> Sysfsm dlacharge sewage to the �Yes �Pto ❑ �c�ted for eurtecs auNet <br /> und surface. ��Searched ior s�ping tn yardlbackup(n homeKO <br /> System dfscha�ge se�rage to drain we • ❑Yes �No � ���8 f��irt sa�systenilD-boxes NA <br /> or surface weters. ❑ Homeowrter tes8mony(�Comments/Euptanatioy <br /> System cause sawage backuP into � ❑Y� �'�o � '81adc soll"above so�diapecsai syeiem 7�0- <br /> dwetitng or estab6sFuner�t • ❑ SYetem�qu�ea°emergency PumP�►9 <br /> MY"Yes"answar above ledicates the systsm Is 0 Perimmed dye teat ' <br /> an Imminant Threet to Publlc Hae/dit and Safety. � �b1e 1°'����"�"��a0�� <br /> . . ❑ ather methods n�lteted(See Cc�,rt�Explar,e�o„� <br /> Gomme�/Explanadon: . <br /> 2. Tank integrity—CnmpBance component#2 of 5 ' . <br /> Com liance crlterta: .. Verfflaation method�s): <br /> System cansists of a seepape p�, f�Yes ❑No ❑ Probed tenk(s}bo�om <br /> '�e�Ocl,dryweU,ar lead�ng pit . ❑•E�m�rted construdion recc�ds <br /> se��eWrsm�roso.z6some�.ee ❑ Exanan�rank� <br /> . r Matrwyadln loca!aaVnmrce. rtegdty�oan(,4ued,} <br /> SewaBe tenk(s)leak below their ❑Y� ❑No 0 ObaeNed Dquld level belaw operattn8 depth <br /> d�i ed o eref ❑ �ned empiy(pum{�t�nkata� <br /> If Yea�whlch aewage tank(s)ieaks: ❑ Proberi outsida tank(s)far'black�iP <br /> �Y"Y�"g�swar�bove Indtcates the ❑ UneEde.to vedh►fsee Comments�xp/anatton) <br /> a�ysEem is FalDng to Protect Gnoundwater,. . ��her me�oas not ttsted�see caonm►enr�rer,auon� <br /> CommentslExplanation: • , <br /> S�-(G �f��rL+1)r� �Sr�►aW� lis'S�t'�"{ Y���`+t� ti�as,�ta�• <br /> 3. Other Compliance Gond�tioas—Cbmpf�nce oom�One�t#3 of 6 <br /> a Maitjt�ence t�1e CCvettt�demaged.c�cked,nn�wreti,cr eBP�4o etrucUnaUy uru�md. �Yes' �No p U►dcnown <br /> b. Othsr issues felect�k�hamrds�.)to invrre�ely aiu!adve�sslfr.knPact PubBc heaNtt or safety. ❑Yes' �No �Unimown <br /> "Sl�rn is an Im►n/rrsnt threatio prrbAa heaTtL anclsnfaty <br /> �P�: <br /> c, Syatem is non-pratedtve ot ground water for other bondiEifons as detan�etl t►Y inBPetl� 0 Yes' �No <br /> `5yatem la taAteg to protectgrarrndxrater <br /> ExPlain: - <br /> � www.pca.state,�.us • 651•Z9tr63a0 � 8�651•38b4� • • TiX b53•282•5332 ot 800-b5l-38b4 • Ava�a6le in attemaNve ta�nwts <br /> wa•w��ar. r�2.si�a <br />