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Feb ,22 2016 04:35PM HP FaxRusty Olson 7634988290 page 6 <br /> Property address: 2811 Farview Lane � <br /> Inspecforinitials/Date: 6122115 �. <br /> 1. It'1't�dCt O�1 PubltC Heelth—Compfiance Component#1 of 5 <br /> Com liance criteriac Verification roethod(s): <br /> 5ystem discharge sewage to the ii ❑Yes ❑No ❑ Searched for surface outlet <br /> �round su�face. � ❑ Searched for seeping in yardlbackup in home <br /> S�rstem discharge sswage to drain liie ' ❑y� ��a ❑ �cesaive pondfng in sflil systemlD-boxes <br /> or sur(aCe vraterS, ❑ Hameowner testimony(See Comm�ents�Lkplanatron) <br /> System cause sewage backup into ❑Yes ❑No � �B�a�s°�'above soil dispersal spstem <br /> dweliing or establishment. ❑ System requires"emergenc�r purnping <br /> Any"yes'�answerebove indlcate.S ihe system rs � Pe�O���Ye test <br /> an Imminerrt Threat to public Health and gafery ❑ Unable to verify(Sae Comments�c�anat,�on� <br /> __ ❑ Other method5 npt Iisted(See CanmentslExplanation) <br /> Com menls/Exp�analion: <br /> 2. Tank Integrity—Compliance camponent#2 of 5 <br /> Compllance criteria• _ Verffication method(s}: <br /> Systern consists of a seepage pit, I� ❑Yes �No ❑ Probed tank(s)bott�m <br /> cesspoot,dryweli,or leach�g p�t. I <br /> i ❑ Examined construction recprbs <br /> SeePege pits meeUng 7080.2550 may be <br /> com fiarrt it a!lowed in loca!onlrnance. � �m�ned 7ank integriry Form(Attach) <br /> Sewage tank(s)leak befow their ❑ Observed liquid level belaw operating depth <br /> ❑Yes <br /> desi� ned o eratin de th. �No <br /> � Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank{s)for"bladc soil' <br /> Any "yes"answer above indicates fhe ❑ Unable to verify(See Comm�ents/E�cplanation) <br /> system Js Failing to Profect Groundwater. ❑�her rnethods not listed(See�om��ts/Exp/enation� <br /> CommentslExplanation: ` <br /> On 6l22/15,Elmer J. Peterson Co.pumped septic tanks. <br /> 3. Othei'COmpli811Ge CO►lditio�5—Compliance cornponent#3 of 5 <br /> e. Maintenance hde covers are damaged,crack�, ��� ���ar ro structu►ally urtwund. ❑Yes p No ❑Unknown <br /> b. Other issues(ek�chicar hazarrls,etc.�p�immediatey and adve im ct ublic heaRh or sa + <br /> "'SysA9m is an imminent ENreat to publie bealtlt and aafe�y Pe P fety, ❑Yes' ❑No ❑Unknown <br /> Explain: <br /> c. 5ystem is nor}protective o/gr�o�md wa�r tor other conditions as determined by inspec.rtar ❑Yes" �No <br /> `3ysiem!S far(ir►g to prahact g�oundwatar <br /> Explain: <br /> www.pca.state.mn.us • 651d96-6300 . 80Q-657•3854 . TTY651-282-5332 or 600�657-3864 . pvailable in altemative formats <br /> wq•wwists43f • f/24l}2 <br /> - ` Po�eZof3 <br />