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:I! � � . .'�iL 1.�• '�I 4f_��'���, ._��� 1� r':�',�aE s':. _t' <br /> Pmpeny addrec�. 1510 Green Tree P,oad _ ______ ____ inspector initials/DatA: JS L 5/37/2013_ <br /> _ ---_ --------------_--- (mml�d/YYY�) — <br /> 1 . Impact on PuUliz Hea[th — C�mp�i�nce c�rnponent'#1 of 5 <br /> C��rn�liance criteria: _ ____ Verification method(s): <br /> _ _. _.. _-- _....- - - <br /> � r� r ,f.% ;e:arched for surfacP ouilel <br /> System di�chargPs se�v�ge to the i _, Ye^, j�_] ,Jo a � <br /> qruund surface. __ _� _ _______ � �earched for seeping in yardlbar.kup in home <br /> System disch:?rge:sewage to drai�i I L� Y�s �� Nn ❑ Excessive ponding in aoil systemlD-boxes <br /> tfle or surface waters_ _ _ _ ❑ I lorneowner t�stimony(S�:e Commenr:✓Fr.pt�narrorr, <br /> SyS(PRl C7l�3BS s�waye bacY,up inSo L� Y�s 4� +'do ❑"L'lack soil"above soil d9spersal system <br /> dwclling or estabiishment. <br /> --- _..- ------ -�- ❑ System r�quire;"emergency' pumping <br /> �ny"yes"answer above irrdicafes the (] Performed riye test <br /> sysiem is an imminent ihreai to publ�c ^� <br /> �._1 Un��J�A IO v�?f�fV(See CominerrfS��splan3fionJ <br /> healih and safety. <br /> `] bthe!metha4s not fl:ted(Seo Commenls/Fx�l�n9t;vn; <br /> CommentslExpTanation: ` - ---�----- - --- <br /> 2. Tank Inte��ity—Compiiance component #2 of 5 <br /> Compliance r,riteri:r._ _ Vetificaiion method(s): <br /> --r--- ------ --- <br /> 5v;t�m consists of a sePpage pit. j L I '�As �'� No `] Probed tank(sj bottom <br /> c?sspool, d�VweN, of leachiny pit. ��c� `Yaminad cnnstrur_t+on recnrds <br /> SAepr+ge pi(:lnARll/1CJ 70�0.?,50 rnay he I ❑ EXBfnineCl Tank Integriry F��rm fr7Q�ecnf <br /> cnrnpfrant rP arlowea in roca/orc�inance.-- --- _- - -_ ..- <br /> []Okserved liquid IevPl relnw pperel'Inq dAplh <br /> 5ewap^tank(s)leak below their [) Ye.^, �� No <br /> �ie:iclned aperatfng depth. � Examined empty(pumped)tanks(s) <br /> It y�s, vihich sn�,vage tank(s)leaks� I ❑ Probed outside tankfs) for"black soil� <br /> - ---- -- _.-•-------_.. �._ ._----... .- - - ,- <br /> fally "yes"ans►ycr abvve indicales tlTe ,_1 unaoie to verify;5Pc Commr�n;s/Exp(enafion! <br /> SjiStEfTl JS ��Il!l1CJ �O pCOfeCI f�l"OU(]CIWc'if8f. �_� Other methods not IiStBd (See Comm�nts/Explana(ionJ <br /> Commen�.s/Explanation: �W � <br /> 3. Other Compliance Conditions-_Comp�iance compor,ent#3 of 5 <br /> a. M�intr_nance hul� covers arP damac7ed, cracl;ed, un�ecured,or appear ta be structurally unsound. ❑Yes' � N� �]Unknown <br /> b. Othef isbues j�l�ctrfcal nazarrls,efc..}lo immediately an�a0versety irnpact puGlic h�alth or safety, ❑Y?s' (�No ❑Unknotivn <br /> 'System/s an fmminr.»c Ihresf fo prfblin c��altll and safety. <br /> F_xplain: <br /> �. Sy�t�m is ncn-pratee:tive nf grnuntl wat�r for othr+r r,r�nditlons as dr�?�rmined by i�spectar �Yes' �No <br /> 'SystAm i.failirtg fo proter_t qro��ndwate�. <br /> �xplain. <br /> --------- --- ' . _----�r--� .-"_- -------._.., _..------_.._--' _..v.w-----�.._---.. . <br /> ��.�n:a.s:ate.mn.us • (��1•29G.5?00 - 900-51%-3qr,n • TTY G51-1,8'L-5J1�o�30Q L57-3E6A • Av�iiablp in�li4rna*.ivn(orn3t; <br />