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SWF.DLUND SEPTIC SERVICE RECEIVED <br /> 9520 L,aketown Road <br /> • - ' - - Chaska, MN 55318 ,J�� p � 1997 <br /> Mi�uiesota Pollutlon Control Agency (MPCA) ��-�Y OF O q��FT <br /> Inspection �'orm for Existing Septic Systems <br /> — ' <br /> pATE�F1�LSPF,�'TI�)N;�O 2`r 7� T1ME: 7, •a' �^'��WEA7HEK CONUI"f1QNS:C��'�„�, IS1'S PERMI7 NUMBER: 39a <br /> RRA$OJd F(1R IvtiPF.('TION ' . �) <br /> O Bcdn�i�rn or bathrcw?m adAition Property rr•ner{s) ���5 Telephane O <br /> �>v�,;�,« Site Address_ ao �� //�aS' D Q City � <br /> � ►— • '/ - <br /> ()Co Iaint Zin COde COUnty fyE.vr� <br /> 1 <br /> Prn�rty Trans(cr Flte No. ownsliip Name <br /> O Qther Is s�slem npcned up'! Y Full P�tli�l <br /> �Y�T��� , 9 . <br /> Has lanlc(s)ever been pumped? �r1 Ycyr System�uflt�_._ <br /> 1(Yes,huw oftenl 3 s Fo�what�easqn:�routinaly �basa��cnt buc:kup0 sluggish plumbing0 other <br /> Any rcpnir done un sya�rm? Y Wha� � When By whum <br /> C's:ge: O o,he.est��lisl�n,er,,E7d,•�:lli��C'? se.^„an�!Q nth:� _ No.9xdroa�;�s - hb. of acupants <br /> Wolcr uafn�appliances: 1'�lothcs wazhu 19��shwasher�9(,arbagr dirposnl O Whulpool bnth OWnter tonditioning unit O Sdf-c►eaning humidifiu In(urnuce M1tAresl <br /> Surface Water: = h from which type of surfeee�watcr O riveA lnk� streArTO other _�_� <br /> (Check appropn�te sewer system eomponent 3nd indiFate Iocation on site sketch on back oF Form). <br /> Tank s : Tank(s) Materinl: Soll Treatment Svstem: Other; <br /> �' Scplic lank �,Fibcrglass ; �rock trcnch �altemative system (identiFy type) <br /> Acri,bic tank �Plastic �gravcllws Irrnc�h �experimental system (identify type) <br /> �Pump tank _,�tctal I ^chambcr lrench _alhcr(idrntify typc) <br /> _Holding lank �Concrete I �epage bed _ � <br /> �Other ,� _mound <br /> / � at-grEidc � <br /> T�nk(s)Si���/2`S�_�atx Soll treslmen�area Flze(s): 3 9�_ � z Ry,(Y, <br /> I <br /> C:O\qFC.T,�!�(`F.[NtipF.('TI(lN• I <br /> Ls_thrrz vr hi�:the[c:_�v_c.���Fn anv cvidencc oF: es e Ex I i <br /> Dischargt of stw��c tv lhc ground surFacc7 yE� _ <br /> pischarse of�ewa�;t to�surf�ctµ-aler? ; YES ' <br /> A serpage pit,drywell,cessp�l or leaChing piI? YES O <br /> Less �han three feet of rertical separation between tfle soil treatment system <br /> h��tti�m and�aturated si,it Ur bedrock? Y�S <br /> StW16z V1C{:ll(f It1I0l�N'elling ur oth�r tstablishmenth YES N <br /> Situations with the potential to inunediately and adversely ittlpact ur thr�nten <br /> p�hi:�r,��!;h or saf�:,� YES r� <br /> • if Y�S w•as an5wered for any�of�he above qu�stiotls,the systtm Is failind Accordin �o M�nn.R,ch.7080.0060. <br /> ST T �S OF T .SyST ,M I <br /> Base.d on the compliance lnspection conducted nbo��e the s ste�i�atatus is -//v ���/" /� A�� � <br /> y ,lherefore, <br /> /����— �� n�� J I A� {Choose: in complianct pR failing ) <br /> this docume�t Is a _ �- l..' C � <br /> (Choose: Ccrtificate of Compliance OR Nptice of I�oncotnplianct ) � <br /> � --- <br /> CERTIFICA'(TnN � <br /> I hcreby cuiify as a statc of�.tinnesota licensed Inspector,besigner f or Qualified Employee that my obs�rvations r�corded on this form ue <br /> Hccuratt as uf the datt al tht tnp of�his Form[or the 6ite statcd ahove. No de.ternlination of future hydraulic performance can be made due tu <br /> unknown cundilions during s��s�em construction,future water usagc over thc life of thc sy<c�:�;, abuse of thc system,and/or inadequate <br /> maintenance a11 of u hich will adversefy afFecl the life of Ihe syslem. , <br /> {n�pcclor's namc�� �4��d�L' /v � Yhunc No� 2-i'"�-�-� •�9J� <br /> � Liccnsc andbr Rcgistration Nurnber <br /> (plcesc.print) <br /> ln<pe��or's s�gn:,lure-- � Datc � —L� ^ 9/ <br /> � �__ <br />