Laserfiche WebLink
Propariy addre�ss: I �:V� '�-���C,W,r��.(1T <br /> �-�-� �� lnspectorin€�aEs/Date:����2�o-S�! <br /> 1, tmpact on Public Health—Compiiance compoaent#1 of 5 <br /> Com liance criterla: VeNficatlon metfwd(s)• <br /> System discharge sewage to S�e ❑Yes �No ❑ Searched for surfaoe ouUet <br /> round surface- � Searched for seeping in yaM/badcup in home� <br /> System discharge sewage to drain�le ❑Yes �No � ��wg���5 in soii system/D-boxes tS0 <br /> or surface waters. ❑ Momeowrter testfmony{See Comrnents/�cp�anation) <br /> Syatem cause sewage backup iMo ❑Yes �No � �s��S°�above soil dispersal system�S C3 <br /> dwelting or establishmen� ❑ ��m�qutres emergency pumping <br /> ❑ Petfocmed dys test <br /> Any"yes"answer ebove lndlcates the syai�em 1s ❑ Unabte ta verify(See CommsntslE�cpla,�ation� <br /> an lmminent Thr+�et to PubHc Hea/th and Safety. [j p�����not ttsted(See Comments/F.xp/ansbon) <br /> Commenfs/�cplanation: • <br /> 2, Tank Integrity—Campliance component#2 of 5 � <br /> Com liance c�it�r�a: . Ver1flcatlan method(s)• <br /> Sysfem oonsists of a seepa88 Pft, ❑Yes ❑No ❑ Frobed tank(s}bottor�. <br /> cesspool,drywe{t,or teaching pit. ❑ Examined construct�on recorcls <br /> Seeaep^e pits meebng 7080.2550 may be ❑ Ezamined Tank integrity Fom�(Attech) <br /> lient if eNowed/n lpca/oidMsr�Ce. <br /> Sewage tank(s)leak betow the€r ❑Y� ❑�o ❑ �bserved itquid ievel belaw operating depth <br /> desi ed o rattn de th. ❑ F.xamined emPfY(PUmP�tantcs{s) <br /> tf yes,which sewage tank(s)ieaks: ❑ Probeci autside tank(s)for'btack soti' <br /> Any "yes"answer above ina�cates the ❑ Unab[e to verity(See CommentslE�cpianaHnnl <br /> system is Falling to Protect Groundwater. ��'���s�'0��r����►ments�xprenanon� <br /> CommentslExplanation: . <br /> S�-� ��Cv�u�� �,��a�� tu��-ti��{ ���� � ���k�.,�-o�.-.�. <br /> 3. Other Compliance Conditio�s—Compliance component#3 of 5 <br /> a. Maintenance hote covers ar�e damaged�aadced.unsearred,a aPAeai'to struduraUy unsaurtd. ❑Yes' �9 Na p unknown <br /> b. Other tssues{elec61�c�1 hszerds�etc.)to immedietety and edve�sefy impad pubfic hea�th or safeiy. ❑Yes` ■No ❑Unknawn <br /> "System Is an lmminertt lhrsat to paWlc health and safety <br /> �cplain: � <br /> c. System is non-pcvtedive of ground wa6er for other bond8ons as d�ned b • <br /> �y�r�r�m,��o pro�t�ndw�reF r�� ❑Y� �r�o <br /> Ex�alain: <br /> www.pca.state.mn.us • 651•296•530t1 • �0�'i7•3864 • • TTY b51-Z8Z•5332 or 80Q�b57•38b4 • Avaitable�attPmai�fire forinatr <br /> W�uw�ileirA_71 _ 1 f 9/f 19 <br />