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<br /> o r , ,.,.�,.,. Sf�tem st��s: c� orr,�liant ::.i NoncomAl�ant
<br /> : (as dete� j d by th t fo�nf
<br /> Soil Separatian Gampti�nc�and�ther Comp{iance-C^?7;;li�nce Inspection Fo�f��Existing SS-S
<br /> Compliance lssue#3 of 4
<br /> Pate nf�bse^:aGon a�Og"p Reasar.fr,r-:bservatic^ R�a'Estaie T..3nsac;,on
<br /> 7h%e�-:!nr.r,a.;,,..:rr f1:tis` ..,-r.>F>�;:�'ez�: �..
<br /> Compliance qucsti�nslcriteria:;hnq�.:�red> Verification Method'":10pr�r,al)
<br /> �C!�r� ..,::�:�: ,-ti,;,�� rC,,..,�v the a��r„o,^.na!e b�x)
<br /> °ar systems built Crrr to n�ri�i,1996,and not � �onduned soll ob5�^aation(s}(attach boring logs)
<br /> �o•.,,t�.t��n :.��..tin.��: �:e:l l� �,- °rctec'�:or. .
<br /> Are:or r�:,^r.,^ a`nrd t�v�r.,>7;^r ❑ Tvro prev�ous verifications(a+tach bec^9 io95)
<br /> Ldy;r- '';..':!nent [.] Other.
<br /> pnps the system have at�e^s'a two-toot
<br /> vertiCal sef�aration�s'2;^c�`�^.m^e^adically
<br /> sah:ra'e'so1!or b� :.ock? t,,Yes �yo
<br /> c^r nOn�^.F.`.-,'n•;�^"r ap?l�:•"�s built G�ri'1.
<br /> tcan� pr I or o.'^,non;:r^��rr^a�ce s �
<br /> I�ted m"`a�,-' 'nr .';ni:hr'.n P.^• ✓+�� Scd e!;sen•ation d^es not expire.P•eti7ous observat�o^s
<br /> � � � by two indeperderrt p�Ries are sufflc,ent.unf,^ss site
<br /> Areas or��r�;^^a food,be c �'7�o�iodG'�^ ,-.�rdi±lons have heen ai;er,�d.
<br /> r,s';�biis`�„^_.. �
<br /> Dces the svs2.�m!:acc a nxE:r.�C�ot r^+tic�a! �
<br /> SC❑�.�?IIO"+Cas .^.C2t•",•••OarG:ir�!I���'..J..;fO!�
<br /> .�od�r�:�Ut�_:;.k?• . . r;Y@S .��NO
<br /> Fo�rcd,eF�,s�:p r'�'.�t'.^: sy�ten��(�e. • ?hcry f� �'fa;c,e�r b u to Y5 per�on!zl ailc»ved in loca+l
<br /> 'p�rf��:..,ancc�sy..�r_ .�,.,.,... . ,.:(I3t,_.'.9 or �; �+ Y P
<br /> ''voC N Of V g•;•�f' t",r_�,•nPv "$0 23`s��Jr . 3:..rr,�ncr,
<br /> ''�?0?4!Ntj ..Nc s.'ar,�!an,!::o!om!c.xrc'o Thrs lis!ic^.o+exbaust,re.
<br /> p�e -:T-rt the des�gned v��r''�.�� in seq r ial�rrt�r,nor dae it indmale which
<br /> � Ca7; ll ,r�^�'t r nrq!^;c.n,!prna?�Clh�S
<br /> se:�><a� t ir ii ,a��c-�:_^�P .:.,iically sati.rr:D�d
<br /> c��.!oi C1,4..�.,.Ar .L_�Yas ❑Ng defr r�a r�-�Non.
<br /> �Cny"Ro"�rrswr�ir:dreates fha'the system i5 faiting Mprotecl
<br /> �m:md a•a.cr.
<br /> �Pftt�ll:dLiQf1
<br /> This� '^'is to be c�^+G�"ted a",`'.att3thed to the S��r'^•ar:�crm nf t c �din�esola?+'tuUon Cc�t.%Aqency's(MPCA)Compiiante
<br /> I�spe..'.acr Fcrrn for ExisGng S��bsurtace Seway4 7reatment Systems.Observations,int..r;r etat: �.? and..;n^lusions must be
<br /> �.^�^!afrf(1 bv an i '__''p� �:�^:^r C�^��:leted`0'�1 mu5t b2 Si�D""�:M^d t0;h���cal umt oi gover*'r+�n!v,n!!�;n 15 d2ys.
<br /> Pr•.�,r^,;Ov.airr ....^,S). '�.'+'.'t C�vr�G•�
<br /> Prooc^.�.,�9^!r^ss 8�Luce Une Ridqe
<br /> • Pron��i� ,, ... ,•�.�s5 p i _..,_
<br /> Cr.en•y ��°.,a��.,:.i (`'apc^y Cvrncr phon+^
<br /> ;hemhv r�r!T'y ��, ;��<�� �:Hv-r.<�:de t`�e�bser� . ,r.: ,'nt�mtr.'aticn�,,�nd c�nelusion.s repc>r,'rd on this form and'7�n�ttrey ca...
<br /> CG�'F.,^f.
<br /> hc�^� C`a�'�^^!`;nski C��rtir �'•o�a�a���,has: 85
<br /> $usino�s IiCenr.�r;c8 end nirm�r,r Las`�in ki �.c''�C�?�sice� or
<br /> n ia:?s�-Jf I����?'. ....��a.�3�+1,*''�i�' i�-;<-f�rOnO .
<br /> c. ,=t�re j'�.r ` ,r.;,[e 4l6i10
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<br /> �r.r..�r:c.sr.itr�__.:x • 651.'05.6300 • 806��.'?:864 • TT'!b57Q82-SS32 or 800�G5?�38(ri • AvaiiaMe 9n a„��..r,a!rve<i�m,�'s
<br /> wo..w.._'-a-31 . �;2n;09 , ,+^4 oJ 8
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