Laserfiche WebLink
t <br /> Parcel number. 06-117-23-23-0018 System status: ®Compliant ❑Noncompliant <br /> (as determined by this form) <br /> Hydraulic Performance and Other Compliance <br /> Compliance Issue #1 of 4 <br /> Date of observation: 6/28111 Reason for observation: Property Transfer <br /> This form expires upon next inspection or in three years,whichever occurs first 6/28/2014 <br /> Compliance questionsicriteria: (Required) Verification Method':(Optional) <br /> Check the apprapdate box (Check the appropriate box) <br /> Does the system discharge sewage to the ❑Yes ®No ® Searched for surface outlet <br /> round surface? <br /> Does the system discharge sewage to drain [I Yes ®No [I Performed hydraulic test <br /> file or surface waters? 0 Searched for seeping in yard <br /> Does the system cause sewage backup ❑Yes ®No ® Checked for backup in home <br /> into dwelling or establishment? <br /> ❑ Excessive ponding in soil system/D-boxes <br /> Do other situations exist that have the ❑Yes ®No <br /> potential to immediately and adversely Homeowner testimony <br /> impact or threaten public health or safety ❑ Examined for surging in tank <br /> electrical unsafe covers etc.)? <br /> Any"yes"answer indicates that Lite system is an Imminent ❑ "Black soil"above soil dispersal system <br /> threat to public health and safety. ❑ System requires'emergency'pumping <br /> ❑ Performed dye test <br /> Does the system pose a threat to ground ❑Yes ®No <br /> water for any conditions deemed non- <br /> protective as determined by the ins r? <br /> "Yes"Indicates that the system is falling to protect <br /> ground water.If"yes".describe the condition noted. <br /> No standard protocol exists. This hst is not exhaustive, <br /> in sequential order,nor does it indicate which <br /> combinations are necessary to make this determination. <br /> Certification <br /> This form Is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance <br /> Inspection Form for Fidsting Subsurface Sewage Treatment Systems.Observations,interpretations,and conclusions must be <br /> completed by an inspector.Completed form must be submitted to the local unit of government within 15 days. <br /> Property owner name(s): John Tasted <br /> Property address: 210 North Shore Drive,Orono,MN 55364 <br /> Property owner's address(if different): <br /> County: Hennepin Phone: 612-382-4952 <br /> 1 hereby certify that I personally made the observations interpretations,and conclusions reported on this form and that they are <br /> correct. <br /> Name: Joseph J.Olson Certification number. 1255 <br /> Business license name and number. Rusty Olson's soil and percolation testing Lic#810 or <br /> Name of localunit ove of Orono <br /> Signature: Date: 7106111 <br /> wq-wwists4-31 Compliance inspection Form for Existing SSTS <br /> 414108 <br />