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Feb ,22• 2016 04:35PM HP FaxRusty Olson 7634988290 page 6 <br /> � � �������� <br /> � <br /> Property address: 2811 Fanriew Lane f <br /> i. Ins�eclor initiala/Uate: 61?2115 . <br /> 1. II'1't�dCt o�l PubllC Heelth—Campliance ComponenE#1 of 5 <br /> _Compliance criteria:_ Veriflcation rnethod(sj: <br /> System discharge sewage to th� �Na ❑ Searched for surface outlet <br /> �round su�face, _ ❑ Searched for seeping in yard/backup in home <br /> S�rstem discharge aswage to drain tiie ❑Y� ��a ❑ ��ssive ponding in soil systemlD-boxes <br /> or su,face waters. ❑ Homeowner testimony(see Comments�xpranauon) <br /> System cause sewage beckup into ❑y� �No ❑ "$�adc sal'above soil dispersal system <br /> _dweliing or esiablishment. ❑ System requires"�mergenc�pumping <br /> AnY"yes"answer ebove indlcates!he system is � Pe�O�'��Ye test <br /> sn Imminerrt Threat to Publfc Nealth and Safety. ❑ Unabie to verify(Sae GommentsiExplanah�on) <br /> ❑ other methods not listed(See CommenLslExplanafion} <br /> Com ments/Exp�anati on: <br /> 2. Ta�k Integ�ity—Compliance component#2 of 5 <br /> Compilance criteria, _ Verffication method(s): <br /> Systern consists of a seepage pit, ❑Yes �No ❑ Probed tank(s)bottom <br /> cesspool,drywell,or leach�g pit. <br /> � � Examined construction reCords <br /> Seepege pits meedng 7p80.255o may be ❑ Examined Tank int <br /> compfiarrt rf aflowed rn loca!orrlinance, egrity Fortn(pnach) <br /> Sewage tank(s)leak below their ❑ ObservEd liquid level below operating depth <br /> ❑Yes <br /> desi9ned oQeratin de th �N� � Exammed em <br /> Ph�(PUmPed)tanks(s) <br /> If yes,which sewage tank(s)leaks:� ❑ Probed outside tank(s)for`bladc soil' <br /> � <br /> A�1y "yeS"answerabove indicates the ❑ Unable to verity(Sea Comm�ents/Exp�anstion) <br /> system/s Failing to Protect Groundwater. ❑aher methods not listed(See Comments/Explanatron� <br /> Co m mentslF�cpt anati on: <br /> On 6/22/15,Elmer J. Peterson Co.pumped septic lanks. <br /> 3. Other Compiiante Conditions—Cornpliance cornponent#3 of 5 <br /> e. Meintenance hde covers are damaged,cracked, u�� ���ar ro struaurally ur�sound. p Yes ❑�to ❑Unknown <br /> b. Other issues(e�hazards,etc.)tp immediately and adversely impact public health or safety, ❑yes* p No <br /> 'System is an imminent tNreat to pub/ic Aea/th and aaf�, ❑Unkrmwn <br /> Explain: <br /> c. System is non-protective oi ground wafer for other co,Kf;6ons as determined by inspedor ❑Yes• �No <br /> 'Syate+n!S failing to prohact gnaundwater <br /> Explain: <br /> www.pca.state.mn.us • 651-2%-630p . 8pQ-657-3864 . T7Y 651-28Z-5332 or 300�657-3864 • Available in altemative formats <br /> wq•wwists43i • f/24112 <br /> _ ___________ Pose�oJ 3 <br />