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IU:Cb.]o,..,, <br />* T-429 P.002/003 F-749 <br />MAY-9-2006 08:16 FRFILICENIER SSOCIATES 7638560901 <br />NAY-04-2008 14:12 <br />- - • Property Owner(s) • _ L Fife No./~fcel Nv. <br />5~~tem Comoonen ca (Please deskxibe @'re system~/nP~en~ and artadr s/te sketch snow/ng systan /arat/on): <br />th d e used tam lee h determin~tlon to the comnllartca Insoecttan7 (Kota; fYost~tiardprvtec>7rtX~ <br />TDe (oAbh~rg llsrls not exhausdvPy Or In sepuelyda/ ordernorindkares rhdr cwnb/naaorrr maynec~ssary ro make a determ/Radt <br />yv~terti9ht pnk(s) , <br />g~Probad ank bottom <br />r~/Dbsorvea la,~r IIgWd Isvel <br />4 Bcamined mtut records <br />O ExaMned emery (pt:rnped) tank <br />CJ probed oucstde tank for'-biadc son- <br />o -prraire/racuum•ehcclc <br />0 otrla <br />Hydnulla Funatloning <br />~/"~~ed for suntan outlet <br />o perfonnod h7draulktest <br />Searched for seeping In Yard <br />p Checked for badrup fn home <br />~ eve pouring tri soft systamjt}boxes <br />~otneo>:mar tstlmom+ <br />O E:mltsined for stugins In tank <br />p "Black sdl-. above soli system <br />o Omer <br />Yertlra! Separatloa Distance <br />CondueseC soli bOnngs _ u <br />DaPth to Iimitlny layer /s <br />Depth to system bottom ~.~ <br />a 0olmined records <br />o {.GU umitlng~tayerverifica7on• , <br />o . Other - <br />tus e <br />Sasetl op the eomPllance rl'lterla, ttse system status is; e;cic one) ~ falling (~„ j(~""Ila~undwatpr) ~ an <br />imminent threat ta'public health or safety (rTPNS), ^ non p0ant (monltofing Issue) Is comp t (none of the ~ <br />prevlaus calditlcrts), T'heretore, tlsis,document is a: rtificdte of Compliapce ^ Narita of Nonwmpl!anoe , <br />Is title system an EPA Clots V Injection Welt? O D no <br />t'ertlfiration <br />1 heretry cernry as a slats of Minnesota gcenseE Inspector and/or Designer I or Qualified Emptol~ee Inspettar and/or Qkrr11Qld t7nplor <br />Ikslgner I that I conducted an Invastiganon that aocurateiy dntermined me compUarKe stalsrs of this system and that my recorded <br />observatlons are amrate as of tllls data. No determinanan of future iM d~uat~ !na teriancea or~ re water usage. e: Ova to <br />unkrtovm con~tfona duAnq system conls'trVetlon, abuse of the system, <br />Inspector's name (pnntl~~ n ('G r ~~ ~e'~~ Phone 6 3 ' 7 ~7,~ /7 ~ ~~ ~9~ 1 <br />license and/or non-Number ~ fir' pddrsss• PO /3 °~ 3 -- <br />t:mployea by ~t!-v,n'S wG '~`^ t ~A'~drest lY10 .,TFe e. l~o,~, /'t/1 ti S`S~ G ~ <br />~ ~_te r~-/ y-~ <br />slgnaNlre - <br />',~Jpgrade.Aeavlrer~ents rdarhedh•wnMbme~bSmtrxesfflS.Sff <br />•Rn IIPX.£ma# bs opgvadaa~ or l~ use dT~vrMrued w27Ar rent mon47t alrecelpt o/this noUcr of wrtA/n a J/tO/t1Y'pe/lad /}` <br />rega/rea br,6rar ovalfnance !/the sysnm fads m praYlda suAforanrgnwmyrrefrrprotecC~n, them brie rysrem mustba upyradecL . <br />~Udced, or!!r rue diuundnrred pdC`rlq dre t7ne re+4kr/ned by ~ ar the kcal ard/nanc+e. If an osdSCing system to norla!lbryas otr/lned or <br />Iaw,, and/ass aCk+11<Aw-+4rrafdrr~..~vN,reaaraoWri Ohar Ohe syms'n used not be upgraoretd, Ieptr/ia~ /t'P~actsa; o12r uSe <br />dfs:eWrbfrrueo; ~ my kr2/ ord/nanct! arac fs mortr st~ct 77rfs abet not appy rb sysse~s /n sfroreAand art+~y wae/gitad <br />p!R~~?an~,•gtCjase lurd/h cavrnsrbron w/U+ /004 bawrragR andkdyvey dYablishmenrs as drllna0ln law. <br />Sttnaested Attachments <br />1) SIt6,;Y,G¢It calkl.alao lndude: wail, we0 SetbacY. to systems drrelOng Or other butklings, tank(;),rtServeC sail treaanant area, <br />surface waterand sell-borfnq'locanons. :nCUde as-built drawing If avallabre. <br />2} ° Scll twnng•toga,•.howing each horizon. IntUCace the textsrre, o;ttor, redv~ttmorphlt features depth to bedrolls: standtnq water and <br />whether rite material Is ftl. ~_ <br />3) n ascot any and an requirements of the Total ordinance that are dttferent from the state r.£qulrements referred to on ~sls forth. <br />91 A homeawrier survey of system performance, stgMed by thq)tomeowner as brlifectuat. - • . <br />S) Mapitoring dap as appropriate. _ - <br />_ _ `~" , <br />• Page 2 of"2 <br />