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70:2638757
<br />MRY-9-2006 08:16 FROM: MERWIN 8 RSSOCIRTES 7638560901 + 7'420 p • 001/003 F-14a
<br />"AY-04-2096 14:12 FRpM-GAIL CENTER
<br />- - 2J29/02 Warer/4Vastawater•I5T59,3
<br />Compliance Inspection Form for Existing Minnesota poltutio~
<br />~,, Indivldua( Sewage Treatment Systems Control Agency
<br />~~
<br />2001 one' Mlnn~sof4 f~ iJH. 7000 na9s1. Pteaso refs
<br />COnlptifloll 0l QNs I~ Itdtllls Ihb nl1r11rnR! requ~ninl.nl~^o~,o~e~ ~o~~m~enca fe0utremonls for bedroom eddlllana. _
<br />SaAII.4t~
<br />Date of inipecgort, ~.:,~1~ Reason for InspeclJon; _=,J ~~~~ /~,1,
<br />-1 c ~/4 ~~F~ ~ `~ • ' -- Telephone ( ) Tel - L/''~ U
<br />Propertyawner(sj~, ~,~~, / (ephonp( )'
<br />Person requerttng lnspeetlo~i ~~ zTp Code-3G
<br />SIleAddrass ~ ..~' ~y~a.Q,_Townshlp~, `• •
<br />Plrs No./ Parcel No. County
<br />t.egal Desaiptlon _ ~ ~~
<br />Loral ftegalatory Authority ~P y~~
<br />.7~ Sjstemin~5hvreland Rrea: yes system In Watih
<br />Date system cpnstrtlcted Fj ••~--- ~5~n ocal Permtt # (If any)
<br />Protection Area: yey~5ystatn serving a MAN Licensed facility: yagr~ u
<br />Systems built prier to Apr11 1, 1996 and nut located In
<br />` Shoreland prWellhead >'{gtettlpn Area or 5erving a Food,
<br />,~.;_r,(,.:.~,~ ~everage ar Lodging Establtshalpnt
<br />~,;,~a `~'"' •:..enr'~I+sr••ny*to avbllehealttror
<br />~ c'L'ne'cti
<br />Dtscna fge oAsetTggito~t(14 gro~~d surfaccsT YES
<br />-•Dlscl~argeofsem~git0.drolntlteorswface.waterd! Y~ 0
<br />.Sewa944?dv!PNI14.~tICe.~gA9Y ,.., ., -
<br />•.Sttyatlon wllA the porentlal to, Immediately and '
<br />adrersety Impact or threa!en prblic health or YFS~
<br />s:+foty?
<br />r rnr,
<br />I>; rna sX~gQl~(a(Ii~t(a yes apsws~/s a fa/Jingsrstem)
<br />= Less'tl~?~1c'JW„Oi~~r~fep4separego~ betwesn' .
<br />. •yjrsanl,opta7m.ty~~-sell ortxdrvck7 1; ~ YPS o
<br />- A =eMa9e•QGSt~D:~Qirr~d): ortQeehln9 pRT YtS~
<br />Is the svsr,,fem non•comDRant?
<br />- I~ s~lh ayslera roputelad under a monltorin8 ptpn of
<br />operating pennN7 Mato, po ro page 2) YES®
<br />(ryes, .
<br />• ties the faquhed monlloAng taken ptece~ YES MO
<br />{ll no, v+4'jgt~p L'9yrW1~n81 • • ~ -
<br />~r1171~D,114ti~L'w4Ti7,o) hg ~! ~'1' ~'7-• • ~'- -
<br />- Doha gte,lAotlHoringlB,dfcate ihat_the syslsm meals i
<br />pe,tpfmm4e v%pogtagonaR YES NO
<br />{!r no, Ino Baum p'nonoomPlytn9j
<br />stems located !n Shorelahd or Wellhead p'.
<br />Areas or Serv-ng a Food, 8cvcrege or Lodi
<br />Estabtlshfiant, or systems Built after
<br />~$ the SY,F~@,Ti '^ ~^ini1^°nh thriaa~ to ny !lc hEatth
<br />or ~~d j~gS BASi'/Ol(S an 1TPf/S3j"SrPf!!}
<br />- Ofscharye of savrage to the ground suti'aost Yf~
<br />. pisd:arga of strrage to dralntlie or surrbte wakrS71't=`' I'PC3
<br />. Sewage ba4irup Into dwelling7 YES 1G0
<br />. 51{uaCon with the pvtentlaf to tmmedlately and
<br />adyersey Impact or threaten publl~ health or
<br />~ safety? YE.° -40
<br />7s the ~...ste tarry, -~-na? (a rrsersrrerlsaTallR~g'syslen7)
<br />- l.esstTan TIiREE feet of vertJcal aeparatlon 6etrreen
<br />system bottom and saturated sell ar bedrpeltl •YES • At`1.
<br />_A~ge pit, cesspool, dfyweA, orleaching pltZ YE' :tom.'
<br />~s she ~~t _m nan-eornollant? ,
<br />- la the system regulated under a moniiddng plan ?r..
<br />ope/altng permit? (I1 Ro, go fo page ?} •• YEr kCt
<br />1f yes, ~ .
<br />• Nas 4f~e required monitoring taken piece? YES ~ Iv0
<br />p/ao, Ule syslsm is rioncorn~lylnyJ
<br />• Ooes the monlloring Indicate that the system me YPS t4G
<br />psAorrrlancv exAectacibns7 ,
<br />prRO; the system !9 non-evmyolyfngJ -..~
<br />L ~ ,..w .~....
<br />Pape i of7r`• - wq=C~wlscsa.3i
<br />•~ ~. - .
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