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T0=2638757 <br />MRY-9-2006 08:16 FROM:MERWIN 8 pSSOCIRTES 763e560901 } 0 p.001/003 F-742 <br />MY-04-2009 14:12 F1i KALL t:Ei RR <br />2/29/02 Water/Wasteweter•l5TS9,3 <br />Compliance Inspection Form for Existing Minnesota Pollution <br />Zrtdividi al Sewage Treatment Systems Control Agency <br />f+vniGfalionOli1Ns/omtluMUstheminlma►requlremenlsofMlnrt_Swaj^jjfe1S5f2ooaaandMiinnsCortbedrn. o0mcns� Pieriarek <br />Date of In�pecgon.� Reason for inspection; <br />,t / � i�w G� .. Telephone( <br />property owner(sj r ir! I , L o4 -r r <br />/ jePhan? ( <br />Person requesting lnspectlori tip Cod.ZC 3 G <br />Site Address S• � y Townshlp <br />Piro Nc4 Parcel No, county <br />Legal Desciption <br />LocalRegalatoryA_H!ority�• <br />stemin Shoreland Area: yes system In Wellhead. <br />Hate system constrtictad - s'/ r' <br />Protection AMC ye129systern serving a Mpm licensed facility: yaq,!!PLoc=t Permit # (If any) <br />Systems built prior to April 1, 1996 and not located in <br />Shorg[and pr Wdhead Prgtectign Area or Serving a Foodr <br />4 f 7f ,•ti . ', �everage or Lodging Establlshmvt <br />t e"}3errt'an`lo�minent'�hreatto'aublteheaithat <br />Disehatge.ol se�sgito,t@4 9ro�hd surface? YES <br />DlSelnatga9f,SlW�ge iD drOhltlie or su fare. YrateW YES o <br />aSew�9R o?aap N>l9,dkyeNng? ,. • , - YES o <br />-Situattori rAth tits potential to, immediately and <br />advafsely Impact or throaten p•Jbllc heath or <br />WRY? TESO <br />-• Nwa <br />�s tneg thine? (a yes a�swsr/s a Taldngsrsteynl <br />Lessth?�1ro,�Y?lxparaCon benrevn - <br />. •sjrseern.oP�.a�N!i+t!�.wq orbedrvcKi G <br />- A sew9e•P.G?�P?,otr`t �ii orW-hing pit? YES 0 <br />�s the sysfem non•ctmoNant? <br />- la the sysiara rogulatad under a monitoring pion or <br />openoling permit? P/•no,;gro to page 2) YES(9 <br />Irrea, , <br />- ties the required monitoring taken place? YES No <br />(lf no, NQ OPIRP pplong) <br />• Do@a ipe,mo(iHotting fildlcgte that -the system mach <br />per(olmange vapogtalfonaZ YES NO <br />(lt no, mo sycom s,'non-0omplym.9) <br />Pape 1 or7r`• <br />,st6�ns located In Shoreland or welineac rrow <br />Areas or Serying a Food, acvcragC or Lodging <br />Establlshment, or systems Built after <br />�g the sY� StBn1 an Imminent threal-to nrihUr hV2fth <br />or safety? .(a t • <br />Olxharge of sewage to the ground SVrfatet Y� � <br />• Discharge of sewage to draintlle or suAce waters? TI:` Itq <br />sewage ba4icup Into dwelling? Yw ITO, - <br />• Sifuetlon with the potential to immediately and <br />adyersely, impact or threaten public health or <br />safety? YE-` )10 <br />is the wstem fa1i11197 (a yrsensrrer/sala/pltgsystemJ <br />Liss than T11REE feet or Vertical separatlgn between <br />system bottom and saturated salt or bedrecid YES 146`. <br />• A seepage Mir cesspool, drywetlr or leachlrtg pit? YE' <br />�s the �33:CA no-comnllant7 <br />- is the system regulated under a Monfloring plan ?[. <br />cpsraling permit? (It no, go to page a) YE`' Rd <br />It yes, <br />Has lho required mon(torfng taken place? YES' No <br />ql no, IN system is lion-corralylny) <br />Does the Monlloring indicate that the system meets <br />performance expectations? , -Yes NO <br />(Hno, "system is non46rnp/y/n.4) <br />wq'-�itiwlstsw .3l <br />