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Aug 0512 08:09p Joseph Olson 763-498-8290 p,5 <br /> Property address. 170 Crystal Creek Road ins�ector iaitials/Date: 8/1N2 <br /> 1. Impact an Pub[ic Health— Compliance component#1 of� <br /> Compliance criteria: Verifica#ion metl�od�s); <br /> System discharge sewage to the � ❑ Yes ❑ No ❑ Searched for surface outfet <br /> _grouRd surface. ❑ Searched for seeping in yard/backup in home <br /> � Excessive ponding in soil system/D-boxes <br /> System discharge sewage to drain file ; ❑ Yes ❑ No � Homeowner test�mony(5se CommerttsiF�rplanatior�) <br /> or surfa�e waters. { <br /> System cause sevrage backup into ❑Yes � I�o ❑ 'Blacksoif'above soil dispersai system <br /> dwelling or estabkishment. ❑ System requires"emergency"pumping <br /> ❑ Pertormed dye test <br /> Arty"yes"answer above indicates the sysfem fs 0 Unable to veriiy (See Commencs�Explanatron) <br /> an Imminent Threaf#o Public Heahth and Safety. Q pther rnethods not listed (See CommentsiExp�anation) <br /> Comments/Exp�ana ti on: <br /> 2. Tank Integrity—CompGance compone�t#2 of 5 <br /> Compliance criteria: Verificat�on method�s): <br /> 5ystem cansists of a seepage pit, ❑ Yes � No ❑ Probed tank(s)bvttom <br /> cesspool, drywell, or leaching pit ❑ Examined construction records <br /> Seepage prfs mae6ng 7080.2550 may be ❑ Examined Tank Irrtegrity Form /Attach) <br /> cam iantifalJowedlnlocalordinance. � pbservedliquidlevelbelowoperatingdepth <br /> Sev�age tank(s)leak below their [�Yes � No <br /> designed operatin de th. � �mined empty(pumped}tanks(s) <br /> Ifyes,which sewagetank(s)leaks: ❑ Probed outsidetank(s)for"blaek soil' <br /> QIJy "j�eS"answer above indicafes the ❑ Unabie to verify{Sea Commen�xp/anat�on) <br /> system is Failing fo Profect Groundwater. � ���r methods not listed (Sse Commenfs✓�xplanation) <br /> Comments/Explanation: <br /> On 8/1/12, Elmer J. Peterson Co.pumped the septic tanks. No cracks or water leaks at that tirne. <br /> 3. Other COmp[iat�ce Co�difiioils—Compliance component#3 of 5 <br /> a. iVhaintenance hole covers are damaged, cracked, unsecured,or app�f to strvcturally unsound. O Yes" �No ❑Untmown <br /> b. Qther issues(electrica;hezaro�etc.)Yo�mm£diately and adversely impact public health or safiety. O Yes` p No ❑Unknown <br /> '"System is an imminent threat to puWic healffi and saiety <br /> �xplain: <br /> c. System is non-protective of ground water far other conditions as determined by inspector ❑Yes` p No <br /> "Systern is failing to protect grorrndwater <br /> E�lain: <br /> www.pca.sta-:.e.mn.us • 659-296-630U • 800-E57-3864 ■ TTY 651-Z82-533Z ar 500-657-3864 • Available in altQrnative formais <br /> wq-wwists4-31 - 1f2�/i2 Pcge 2 af 3 <br />