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Apr 29 14 10:57a Joseph Olson 763-498-8290 p.6 <br /> �._ / � — <br /> Froperfy address: _ 207b Coiin Drive _ ` _ _� Inspector irifialsJDafe: 1/31l14 <br /> � ��- <br /> 1. impc��t or� PubEic Health—Compliance component#1 of 5 <br /> Compliance critena:` �__��_`F Ver�fication method{s): <br /> System discharge sevuage to the ' ❑ Yes ❑ fJo ❑ SearcF�ed for surtace outlet <br /> _ground sarface. _ ❑ Searched far seeping in yardlbackup in nome <br /> System�ischarge sewage ta drain tile � Q Yes {�No ❑ �cessive ponding in soil systemlD-boxes <br /> or sur�cce waters. � homeowner:estimony(see CommenfslExp/anation) <br /> - Q °B�ack soil"above soil dispersal system <br /> System cause sewaoe backup into �i ❑Yes ❑ No <br /> ewelling ar estab{ishment ❑ �ystem requires"emergency"pumping <br /> - — � �-- -- ❑ Per:`ormed cfye test <br /> Ally"yeS"dnSWff abpVB I17diC�2S fhB SyStQR1 i5 � V�able to Vefiiy(See CommentsiExp(anafion) <br /> an Imminent Threat to PublrC Heafth and Safety. _ ❑ p�her methods not listed�See Comm.enrs�xp;anar�onl <br /> CommentslExpianation: <br /> Z. TdnK fnt@�r�ty—Compliance component#2 af� <br /> _Compliance criteria: __, Veri�cation method{s): <br /> System consists of a seepage piE, ' I Yes [ �o ❑ Probed tanK(sy bottom <br /> cesspool, drywell, or leaching pit. i ❑ Examined constr�ction records <br /> Seepage pi.�s meeting 7080.2550 may be ; Q ��rrtined Tank Integrty Form (Attachj <br /> com iantifallowed in local o�tiirance. <br /> �� �—�—�—���� [j Observed liquid fevel belcw operating depth <br /> Sevvageter.k{s}leak befowYheir ❑Yes � No <br /> desi�ned�erating deRth. C�' E%amined empty�pumped)tanks(s) <br /> If yes, wh c't sewage tank(s}le�ks Fv ❑ Probed outside.ank(sj for'black soi1L <br /> iQRj/ "yes"answer above I�d�caf�s ihe � ��aDle ko verify (Ses Comme���Fxplanat�on) <br /> system is Failing ta Protec#Groundwater. � �`�er methods not listed jSee Gamments/cxplanafion) <br /> Com ments!Explz n at+on: <br /> On 1l31!Z4, Glmer J_Pe#erson Co.pumped sept:c ianks. See notes on attached tank report. <br /> 3. Other Compiiance Conditions—Compiiar�ce cornponent#3 of 5 <br /> a h!laintenance hole covers are damaged,crackea,unsecured or appear to struct�rally unsound. ❑Yes" �No �Unkrrov�m <br /> �. Ot�er issues(elecscaf hazards,e�c_)to immediately and adversely im�act aublic health or safety. p Yes' ❑No ❑unkna�vn <br /> `System is an fmminent threat to public health and safety <br /> �xpiam. <br /> c. System�s non-protective oi ground water for other conditions as determined 6y inspector ❑Yes� p No <br /> `Sysiem is failing to pnotecf grourrdwater <br /> Explain: <br /> www.pca.state.rnn.us • 65i-296-6300 • 806-b57-3864 • TTY 657-282•5332 or 800-657-3864 • Avaitable fn alternative formats <br /> wq•wwi<ts4•3; • 1/Z4!12 Poqe 2 of 3 <br />