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Nov 11 2016 09:11AM HP FaxRusty Olson 7634988290 page 15 <br /> r� <br /> Property address; f 045 Brown Road S � <br /> — - Inspector inrtialslp�e 1p/2M16 <br /> 1. Impatt Ot1 Publit Fledlth—Compliance component#1 bf 5 <br /> Compliancs criterla: Verification mothod(s): <br /> Syatem diachn�gc ae�w„�e�o me � y 88��yp' [] Seareh�O!or surface outlet <br /> �und sudace__ � 0 Searched tor sCepf�g in yard/beckup in home <br /> System diccharge aewepe to drain tile ❑Yes ❑ryo ❑ Excacsive ponding In aal aya�arrdp-boMer <br /> w surface wecers. --- _ � Homeowner testlrtanY(Ses cbmmen:aiF�rpranec'ar) <br /> System eause sewage baCKup iMn ❑y� ❑No ❑ "�eck soil"ebovo soil dispersai system <br /> d�uelVingorestabfishment. I C Sysiemrepuires'emergencypumping <br /> Any��yas„answe�r above irrd/cttea the ayatsm is ❑ Performed dye teat <br /> an lmminent Threat to Pubflc Hes/th and Safety. ❑ unawe to veriy(see�mm,ncs�xpraneuon� <br /> -- ❑ Omer methods not listed(Sae commenvs�F_,rae,�enon� <br /> Commertt s�E�cp lartatlon: <br /> 2. Ta�k Integrity—C4mplian�cornponent#2 of 5 <br /> _Compllance eritaria: Verlflcatlon m�thotl�s�: <br /> System cans�sts of a seepa{�e pit, i ❑yea �No ❑ Probed tank(s)bottom <br /> cesspool,tlryvvell,or�aaching pit. <br /> L; Examined mns�rudion recwds <br /> 3eeCepepitsmaatirip7080.2550meyOe ❑ E�tninedTenklntegrityFOrtft{AUach) <br /> wmplianr i7 ellowea rn bcal o�dinent�e. <br /> Sewage taMc(s)leak bebw their ± � � �bserved liquid level below opera6ng dapth <br /> tlesi9ned oPe�depth. , � �YAe �No pty(pumpadJ tanks(s) <br /> � Examinetf em <br /> If yes,which sewage tank(s}leaks: ❑ P�obed oufside tank(BJ for'black sal" <br /> Any`•yes"answer above indi at@8(h! Q Unable to verrfy(See Com�xp(enat�an) <br /> system is F�il►ng to Protect G�oundwatar. ❑����5 not listed(See Ccmrraents/Fxplanet�or,l <br /> Camments/E�lanafi on: <br /> On 1Ql24/16,Elmer J.Petetson Co.pumpeC tanka. <br /> 3. OLhE�CORIpHaflte COr1dlt�OnS—Compliance component#3 oF 5 <br /> a. Maintenenpe hole oovers are dartiaged,clacked,unsecured o�appear C�str�y ur�sound. �Tes• ❑No ❑UNcnown <br /> b, Other iegu2g(e/9�9TCe1 hazartYs,e�.)to immpd'f8t61y and adVM9Cly impaci publiC health or 38fg�y. [J Yes' ❑No ❑Unkno�m <br /> 'System ie an immineM Nrroat tp pnal�h W fh and sah,h, <br /> E7�lain: <br /> c- Syatem is norrprotedive of ground vreDer for other oonditlons ea delermined by inspeUor ❑Yes' ❑No <br /> 'SYcaer+'�Is MJ�fnq tc P+nEect groundwah.v <br /> Expldn: <br /> wt+w-pca.tta[c.mn.us . 65i-2%-6300 • 800-657-3a64 TTY657-25�5332 ar a0f1-657-3g� . Avajlable in altema[ivetormits <br /> w9•�sts1-31 . 1/74l 72 <br /> PCge l of 3 <br />