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Parcel number. z�-iie-z3-4o-000� System status: ❑Compliant �Noncompliant (as defem►ined by fhis fo�n) Hydraulic Perfonr�ance and Other Compliance Compliance Issue#1 of 4 Date of observation: 6/26/9 Reason for observatiort: City update prowam This form axpires upon next inspection or in three years,whichever occurs first: 6/26/12 Compliance questions/crlterla:(Required) Verfication Method`: (Optional) Check the a ro riafe box (Check the appropriate box) Does the system discharge sewage to the ❑Yes �No � �arched for surface outlet tound surfaoe? Dces the system discharge s�vage to drain ❑Yes �No � Performed hydraulic test tile or surface waters? � Searched for seeping�►yard Does the system cause sewage backup ❑Yes �No � Chedced for badcup in home inio dwelli or establishmenY? ❑ Excessive ponding in soil systemlD-boxes Do other situations exist that have the ❑Yes �No � Homeowner testimony potential to immediately and adversely impact or threaten public healtfi or safety ❑ Examined for surging in tank electrical unsafe covers,etc.? ❑ "Black soiP above soil dispersal system An�"yes"ans�ra,r 3ndlcat�that the system is an Imminent threat to public ieealEh and safety ❑ System requires"emergency"pumping ❑ Perfortned dye test Does the system pose a threat to ground �Yes ❑No � �r. water for any conditions deemed non- protective as determined by the ins ector? "�e5"ffldiCBt@5 Z/►af�SySEBAI IS�B�NIg t0 pf7Dt6Ct ground water.If`yes;desdibe the co»dition noted: 'No standaid protoco!exists.This 6st is not exhaustive, Mottled soils in sequerr6al order,nor does it indicate which combinations are necessary to make this determinatan. Certification This form is to be completed and attached to the Summary Form of the Minnesota PoNution Control Agency's(MPCA)Compliance Inspection F�n for Existing Subsurface Sevrage Treatment Systems.Observations,interpretations,and conclusions must be completed by an inspector.Completed form musc be submitted to the local unit of govemment within 15 days. Property owner name(s): RICHARD W.PERKINS Property address: 1699 NORTH FARM RD-ORONO Property owner's address(if differeny: County: HENNEPIN Phone: l hereby cerfily that I personaNy made the observatrons,interpretatrons,and conclusions reported on this lorm and thaf they are co�ct. Name: Mark J Hayes Certification number. RSO'13 Business license name and number: Mir►nesota Geotechnical Servicss,LLC MPCA#L3203 0► Name oF local unit of govemment: Wriaht Couniy Signature: M�J ��b Date: 7112/9 wq-wwists4-31 Compl innce Inspectiai Form for Existing SSTS 4/4/08