Laserfiche WebLink
02/07/2008 13:39 7634988290 RUSTVS PERC TESTING PAGE 03 <br /> 1/29/02 Wabe�/Wastewater-LST54.31 <br /> Compliance Inspe�.'�on Form for Existrng <br /> Individual Sewage Treatment S�/sbems M�nn�ota��uaan <br /> co�ae�r <br /> Cornpletlorr af�is fovm fid9Ns the nurumal►equiremer►ts orMlnn. 5tat§11�56(2009)and A�rme.�ota R.ch. 7080(1�59), Pfease <br /> ref�er to Mca/adrnenr.ea Ib►otl►er req+�iremer�s or l�n►►ne�o�n e�aAY ibi caaun�i�►►ce re9uj►emer�t8lbr bedroorn eddi�ons. <br /> �4 <br /> Wrb�of In�Ctlon: 2/01�/� REASON 1hr inp�ectlon Prooertr� <br /> P�v�1r O+Nn�'(s) scatt�tc�eilenr eoardman T.lephan�(9sz) 476-ss37 <br /> Perswr�eqt�nA H�spoc�ans �orae� Telep��oee(952) 473-3000 <br /> S�Addr�an: iQ�s Gtist�l C��e�lc R�a�cM qtr: Ora�fo Z�C•ode��._ <br /> Fire No./ i►arod No. OouMy: Flennadn 7'orrr�h�Pc <br /> L�gM D�'lptb� � <br /> L,ac�l R�ul�ory Autltority: �af Orono <br /> pabe s�6sm construc�ed: j/19/o2 S�am In Shorelsnd Area:�no S�b�m In wellh�ad <br /> PrvOmd�an Arw: yes� 9rsbwn�nrtng s MDH Homn�ed�dlity: y�s�Laal P�ermlt# (if��y)�Z9� <br /> Syst,err�bui�p11or b�A�rfil 1, 1996 and not located In Sysberns locabad in Sho�e{a�or Wellhead PraQectfion <br /> Sha+eland or W�Ilhead Pmbectiion Area ot Serving a Food, Arees or Servtng� Food, Be�rerage or L�odging <br /> Beverage or lodgfn9 �stabl�hment E�iabl�shi'r�e+'��,or s�►st�ns eulft afber <br /> N�ar+ctt 31 1996 <br /> �fa yes a�tswer g an l7Pi�l5 sy�m) g.�i,(a yes ansr�r 1s an ITPHS sys�ernJ <br /> -ol�a,a�ge o��ra�o�e m tAe gra,na surfaoe? Yes t�o -as�ha�af�ewage tio the Snou�a�,rtaoe? rPs <br /> -OLscharge af 9ewage bo drdllrtlle or SUlfaoe wa6ea5? YES NO -Oisd'�alge CF 9eWage bD dreit�tfle or surfaoe rvah�?YES <br /> -Sewege bac9a�ir�b dwelNng? Y� IV� -Sewage bndaip Ir�dvrelting7 YES 0 <br /> -S�on r�tt�e port,entfal�o ImmediabeM and -SiGuadon witf�the poo�rnfal bo Immedla�belf►and <br /> adve�'�eM hn{�act or tfireaten publk healtfi or adws�y imp�ct or tl►�+eaten publk healRh or <br /> safely? Y� NO �fetyt Y�S QO <br /> �s tl�e sv�m.��(a yes a�esw�r�a�sl'slam) Is��6em falllna?(e yes an�w+er��s e falNn9 system) <br /> -Le�tt�an TN�O feet af vertkal s�atfon betvreen -Less than THfi�E feet of verdcal separadon betvvecn <br /> S�rstem bo�m�ard saturated 90U Cr bedroClft YES NO SysLerll bOtLDrt1 atld 5aQ1f'd�09d 5dl Or bedroClC� YFS <br /> -A SeePage PIt.�ool,drywdl,or lead�ing piCT YES NO -A se�Plt.oe�oof�drywetl�or leeching pft? 1fES O <br /> - Is the system r�gul�ed under a monibo�ing plan o� - Is the syst�em reguiated under a monitorin� pfan r <br /> ys e <br /> oP�g P�� flfna 9�ro v�9'��I YES Mo operadr�g pe�miCr �rtnn, gc,t�page 2� YEs <br /> If yes, f�}�s. <br /> -Has the required moni6oring t�ken plaoe? 1rES NO -Has the required monitaing taken place? YES NO <br /> (1f no, me aysAem!a no►�oirqNYfng1 (t1 rra the sysfi�m fs non-oomplYf�►81 <br /> -The monitoring Indica�e that the system meets -The menitoring indicate th8t the sysfiem me�ts <br /> pertormance�ttons� �3 rro perivrmanoe expectatioas? �rE'S r�o <br /> (It no. H►e sysbem is non-ao�r�fj�l iK no, the syatem is r+wroorr�P�Y��1 <br /> Page 1 of 2 wq-wwists4.31 <br />