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T0=2638757 <br />MRY-9-2006 08:16 FROM:MERWIN 8 RSSOCIRTES 7638566961 } T-4i0 P~001/003 f 740 <br />yAY-04-2006 14:12 fii~F•CALL t:Ei(TeR <br />• - 2/29/02 Water/Wastawetet~25T59~3 <br />,~y~ Compliance Inspection Forrrl for Existing tyJnnesota Potrut3ori <br />~,~,,,,~.,? Zndividua( Sewage Treat:meriC Systems Control Agenry' <br />Cvmcfal(on olldlslotta Iu1RUs thrr mJnlmal recufremenls ofMlnrt_Sta~^~~f e1d3~(coooeav^emaleis Coribedr om oau/ana~ pleaso rek <br />~~ ~~Q 5~~~ <br />Date of In~pecgo~. Y~~ Reason for inspection; <br />- ~ r~-G~ . ~ • Telephone ( ).,~~' <br />Property owner(sj r 1~~~ 04 -r ~ -- <br />/ 1ePhon4 ~ J' <br />~~ <br />Person requesting lnspectio~i iJp Codoy~~ 33 G <br />Site Addreu ..S• ~~y~TOwnshlp , '• <br />Pire rto.l parcel No, ~ Counry <br />Legal t3esaripnon £ ~- <br />LotatRegulatotyA.H!erlty ~• ~ /~~[ rL"'~ <br />,.- ~ stetrrln Slroreland Area: yes system to Watihead. <br />Hate system constTtrctad -~ •..._.~. s'/ ~' <br />Protection Area: yer~ystem serving a MAYi licensed facility: yaq~o~i Permit # pf any) - <br />Systems built prtpr to Aprti 1, 1996 and not lopted In <br />' Shorgiaml pr Wellhead P~gtecUpn Area or 5ervlnq a Food, <br />4 f 7f ~•ti ..~s~~everage or Lodging EstabllshcnGnt <br />,. -• <br />'t ~e" ,}3errt'an`lo~mtrient•threatto'aublleheafthat <br />Dlseha fge.o!•se~sgito,t@4 9ro~hd surfaca7 YF5 <br />'DlSCJratga9f•SlW~galD,dr0111tliCOrSW{aG0.Yya6era? YE5 ~ <br />aSew~9R o?aae NItS.~xeNng7 ,. • , .. - Yes o <br />-~SituattonwltAtfiBpotenCalto,Jmmedtatelyand <br />adYersety bnpad a threaten public haahh or <br />safotyi TESO <br />~-• Nwa <br />~s tneg tilna? (a yes a~swsr/s a Taldngsrstrml <br />= L'ass'Vi?~1t'JWO,~,~Y~,r~ie~lsepareCo~ benre~n.- <br />. •sjntern.oP~y •Aty~yty~es~•wq orbednxKl G ~ Yt:s <br />- A sx~9ev.?.?aP?~4`t><ywerJ: orteZaehing pa:T YES 0 <br />('~ ~ }41'1+,+n 1Lh;Nf,'h /Y•oP• <br />~s the svsfem non•ctmoNant? <br />- la the syslsra ropulalad under a monitoring plan or <br />operelklg pe-mtti P/~-v,;yo fo page 2) YES <br />Irrea, , <br />• tics the roquha0 mon11o0ng taken ptace'f YES ND <br />(if no, NQ a~l~~i~plrln9l <br />Y~ ~t~,.;~pn~,a~4ri~i iii ,°~ n°'~' <br />• Doha 1~6,mo(iHoting fndlcgta thaE;the system meals <br />per(orman~e vnpoglallonaZ YES NO <br />{tt no, No ~yaum p'non-0omplylnyJ <br />•• ~. - - <br />~sterils located In 5hor~lahd or we!lneaq rrote~ <br />Areas ar Serving a Food, 9cvcrergp or Lodglrig <br />Estabtlshment, or systems Built after <br />~g t_he sY~ SIiBiTi 3t1 Irnminent threal-to oabllc hEatth <br />or safety? .(a yes ansr'verls a~ lTPHSsysteml •, <br />~• 0lxharge oP sawaye to Ne ground surtacat Y~ ~~ <br />• ()ischarga of serraga to dfalntlle or surtgCe waters? YE: • I~q <br />.Sewage ba4lcup Into dweiiingT YE.~ 11'10, <br />• 5lfuadon with the pvttntlal to tmmed:ately and <br />edyersey impact or threaten pubtk health or <br />safelyP YE-`' +90 <br />Ys the wsterrLralilrrv7 (a yrsensrrer/saIa/pligsystemJ <br />- Less•tran THREE feet oP vertical separatlon betrreerr <br />system bottom and saturated soli or bednxK! •YES ~ A~`. <br />A seepage pit, Cesspool, drywall, or leaching ptrt YE' ;lOa. • <br />~s the ~33:CA no -comoliant7 <br />- !a the system regulated under a monlloring plan ?r.. <br />oparailnp perrnlt4 (I! no, go to page a) •' YE`' NQ <br />1f ras, ~ ~. <br />•-ias the required monitoring taken place? ~ YE5 • tt0 <br />(rl no, lhd syal9rn !s tion<orrr~lyrny) <br />• Does th• monlloring Jndicale that the syalam meals <br />performance exAectatlcns4 , -Ye5 ~ <br />(lrgo; lho:ysrorn !' non-corrrpry/nSJ <br />~. <br />Pepe 1 oP7r`• <br />- .~..+ <br />wq~~itFwlstsw .37 <br />