8-13-19 Septic Design - Laserfiche WebLink

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Property address: 1960 W- Farm Road 1. impact on Public Health —Compliance component #1 of 5 Compliance criteria: System discharge sewage to the ❑ Yes ❑ No ground surface. _ System discharge sewage to drain tile ❑ Yes ❑ No or surface waters, System cause sewage backup into ❑ Yes ❑ No dwelling or establishment. Any "yes" answer above indicates the system is an Imminent Threat to Public Health and Safety. Comments/Explanation: 2. Tank Integrity —Compliance component #2 of 5 Compliance criteria.- System riteria:System consists of a seepage pit, I ❑ Yes ® No cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be C am lianf if allowed in local ordinance. Sewage tank(s) leap below their ❑ Yes ® No designed operating depth. If yes, which sewage tank(s) leaks: �^ Any "yes" answer above indicates the system is Failing to Protect Groundwater. Comments/Expl an ation: On 7/5/19, Elmer J. Peterson Co. pumped tanks. Inspector initials/Date: 715/19 Verification method(s): ❑ Searched for surface outlet Searched for seeping in yard/backup in home ❑ Excessive ponding in soil system/D-boxes ❑ Homeowner testimony (See CommentslExplanation) ❑ "Black soil" above soil dispersal system ❑ System requires "emergency" pumping ❑ Performed dye test ❑ Unable to verify (See CommentslExplanation) ❑ Other methods not listed (See CommentslExplanation) Verification method(s): ❑ Probed tank(s) bottom ❑ Examined construction records ❑ Examined rank Integrity Form (Attach) ❑ Observed liquid level below operating depth IE Examined empty (pumped) tanks(s) ❑ Probed outside tank(s) for "black soil' ❑ Unable to verify (See CommentslExplanation) El Other methods not listed (See CommentslExpianation) 3. Other Compliance Conditions — Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to structurally unsound. [:]Yes* E] No ❑ Unknown b. Other issues (electrical haxatds, etc.) to immediately and adversely impact public health or safety. ❑ Yes" ❑ No ❑ Unknown *System is an imminent threat to public health and safety Explain: c. System is non -protective of ground water for other conditions as determined by inspector Q Yes* ❑ No *System is failing to protect groundwater Explain: www.pca.state.mn.us • 651-246-6300 • 800-657-3864 TTY 651-282.5332 or 800-657-3864 • Available in altemative formats wq-wwists4-3 i • 1124112 AaQe 2 of 3