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TO:2638757 <br />MAY-9-2006 08:16 FROM: MERWIN 8 ASSOCIATES 7638560901 + 7-420 P • 001/003 F-74111 <br />MY-04-2000 14:12 FRMKALL CENTER <br />2125/02 Water/4Vastat 5". 15rS9,3 <br />Compliance Inspection Form for Existing Minnesota Pollution <br />Individual Sewage Treatment Systems Control Agency <br />v- <br />2001 one Mlnnosor4 a M. 7000 (19999. Please refs <br />Completion of QNs farm Adolls the, minimal requiremonfs Of,oWeUV jar CqM _ neY fe0utremenls for bedroom eddlllana. _ <br />SaAt1.4t� <br />Date of inspection, 1� Reason for inspection; <br />c Telephone <br />propertyowner(sj1- ►t Airs -�— / fephon?( )' <br />Person requesting Inspection sty Vp Code 3G <br />Site Address !� y,_Townsillp�, ` <br />Pere No./ Parcel No. County <br />Legal DescrIptlon <br />Loral ftegalatory Authority P y <br />7� Sjstemin.5horeland Area: yes system in Wellhead. <br />Date systebl constructed f j .-- �5�n ocal Permit # (If any) <br />Protection Area: Ye S/ 5ystaM sen+ing a MAN licensed facility: yegr u <br />Systems built prlpr to April 1, 1996 and not located In <br />Shoreland prWellhead Pfgtectlpn Area or Serving it Food, <br />�everage or Lodging Establ)shmvt <br />, c'tne'cti <br />r.:enr'thsrny*toavblleheatthor <br />Dt"fge oAsevlggitoJ,t(ig greed surfaces? YES <br />-Dlschargaof,,semJgitgdrelntlteorsurface.waters? Y6 0 <br />.Sewa94 b!PPIl4.Meong? <br />•.Situation rvlth the poten9a) to, )mmedlately and <br />adversely kWct or threaten public health or YFS� <br />surety? <br />r ry,r, <br />I; rna sX gQl�Gnl.at(a yes apsws�/s a A1111.q srstem) <br />Less ?�IrJW„Oi� ojry rSle�4sepsr!gotn betwesn' . <br />Systerrl,optaotm.ittt�tyaell ortxdrvek7 IT YES <br />d:orteehl^pT OA #s the sysrfem non•romDRant? <br />la the sysiera ropulalad under a monitoring plan or <br />operating permN7 Rfrto, go ro page 2) YES® <br />lr yes, . <br />• Has the requited monitoring taken place? YES NO <br />(Mno, "TIML'9 W�n81 <br />�rlti'1�n114tiLw4Ti7,r).hf{!"�"'1'�'`P••• '- - <br />- Doha Qte, .gpgorbtg lBdfcate 1,hat_the system meela <br />pariorman4e nipoglallonaR YES No <br />(itno, ere Baum p'nonoomplytng% <br />stems located In Shoreland or Wellhead P <br />Areas or Ssr Ing a Food, 8aycra94 or Lod <br />Estabtlshment, or systems Built afar <br />Ls the SYF @,Ti 'ar• XMLj Mt thriaat to au llt health <br />or safa�t�id iw ansrmris an iiW5system) <br />- 01scharge of sewage to the ground surface? Yin <br />. Discharge of sewage to MIMIC or surface waters? Yf RQ <br />. Sewage bagkgp Into dwelling? YEV 1G0 <br />. g6mdon with the potential to tmmedlatey and <br />adversely impact or threaten public health or <br />safety? YE.° ►40 <br />7sthe�..ste to, I)Inor?(0rrsensrrdrfsalallWS?Stem) <br />- Lm(han THREE feet or ygrtical separation between <br />system bottom and saturated sell or b6*vd 7 YES • A�1. <br />-Aeaepage Pit. cesspool, dfywell, orleaching pit? YE` .�.' <br />ss the ��t _m nun-eorf�oliantT <br />Is Inc system regulated under a mon6ring plan 1r. <br />cperaling permit? (If no, go to page 2) YEr kCt <br />Has the required monitoring taken piece? YES' No <br />ill no, Me sys(sm 1s rionc"lyrng) <br />ones the moniloring Indicate that the system moose 01G <br />performance expectations? , <br />pl Ro; rho system !9 non-evn'yolyfngJ -..� <br />L , ,..w .�.... <br />Page i oftir`• - wq=C�wlscsa.3i <br />