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Mar 11 13 01:25p � Joseph Olson 763-498-8290 p.4 <br /> � <br /> . ��� � � � <br /> Property address; 'f60 Goldenview Drive inspecfor initialslDate: 6/'i3112 <br /> 1. Impact OIl P l[C Health —Compliance companent#f9 of 5 <br /> Compiiance cr ena: Verification method(s�: <br /> System cEisCharg sewage to the [1 Yes ❑ No ❑ Searched for surtace outlet <br /> rouna surtace. ❑ 5earched for seeping in yard/backup in home <br /> � System disGharge sewage to drain tife + C Yes ❑ No ❑ �cessive ponding in soil systemlD-boxes <br /> or sur#ace waters. ❑ Homeowner testimony(See commentsiExplaRation) <br /> "---- ❑ "BIacK soil"above sail dispersa}system <br /> Systetn cau�e sewage backu� inio ' ❑ �'es Q No <br /> dwelling or establishment. ❑ System requires"emergency" pumping <br /> � Performed dyetest <br /> Any"yes'i answer above indicates the system is 0 Unable to verify{See Comments/�xplanadonJ <br /> ar�Immin�nt T reat to Public Nea�th and Safety. 0 O#ftet'metttods rtot listed (5ee Comments/Explana6onJ <br /> CommentsJExpla ation: <br /> � . � _ �' , - � --�,,- <br /> r <br /> 2. TanK int I��rity—CampCiance component#2 of 5 <br /> Complian�e crrteria: Verification method(s): <br /> �-7 <br /> System con�ists 4f a seepage pit, I ❑ Yes � No ❑ Prabed tank(s) bottom <br /> cesspool, d ell, r leaching prt. I ❑ Examined construction records <br /> Seapage piFs�neetrr�q T080.2550 may be ❑ Examined�ank Integrity F�I'rn(Rttach) <br /> com lian[ifaUowedrnlocalordinance. <br /> ❑ Observed liquid ievel below operating depth <br /> Sewage tan�C(s)leak belowtheir ❑Yes � No � �camined empty(pumped)tanks(sJ <br /> desi ned o eratin de th. <br /> If yes,whicl�se e tank(s)leaks: ❑ Probed ovtside tank(s)for"black soil" <br /> ' ❑ Unableto venfy (See Commen.tsiExptana6on) <br /> Any "yP.S"al! er abov+e indicates the � p}her methods not listed (See Commertfs/Explanafion) <br /> s�rstem i�Far Eng to Profect Groundwater. <br /> Commertsf planation: <br /> Or�6/73/12, Elmel�J. PetersoR Co. uncovered manholes and pumped septictanks. See notes on attachedtank report <br /> I <br /> 3. Other Cqmpl�nce Conliitlons— Com�liance componertit#3 of 5 <br /> a. Mainten�nce h�le covers are damaged, cracked, unsecured,or app�rto structurally unsound. ❑Yes' �No ❑Unlvmwn <br /> b. Other iss�es(slecbical haza�ds,etc.)to immediately and adversely impact public heafth or safety. ❑Yes" ❑No ❑Unknown <br /> "�ystemj is ari jmminent threat fo public heaT�and safe#y <br /> I / <br /> Explain: ' <br /> c. System i n�n-�rotective of gro�nd water for other conditions as deteRnined by inspector ❑Ye�' ❑No <br /> *Sys is fai/ing to p�otecf groundwater <br /> Expfain: <br /> www.pca.state.mn.�s • 651•296-63Q4 • SOQ•657-3864 • TTY 651-282-5332 or BDO-657-3869 • Rvailable in alternative formats <br /> wq-wwuCs4-31 • 1%24f 1Z Page 2 of 3 <br />