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MAY-9-2006 08:16 FROM:MERWIN 8 RSSf]CIATES 7638560901 ~ <br />NAY-04-2008 1d:12 FR~FCAII CENTER I , - <br />- - • Property <br />~gtem Components (Please dest~be 6're <br />IU:dt>JOw, <br />T-420 P.002/003 F-Td0 <br />Ftre No./ tercel No. <br />and attach s/te sketch show/n9 ~~ ~~J~ <br />I,y ~ ~ • to make the datertnin~tlons to the comvlla EglnsoeRton7 (Note: No statttia(dprolDa~lext <br />7TJQ (o/lOWti+9 IISC /S notPYhdflSdYei Or /n sequsnfla/ ordernormmcaras rmrwr cwr.uu.-'~.. ... ~ necsrsarY ro make d dalelmhlaCC <br />Watertight tank(s) , <br />y~Probad ank bottom <br />t~/Obsarved lore liquid level <br />q [3mmined cotut records <br />p C~ramined empr/ (Pt.'mped) tanK <br />Q Roped outside tank for"bladc son" <br />o •preavre(vacuum-check <br />a oma <br />Hydrsulla Puneeloning <br />~sprcFtad for Nrtap Outlet <br />d peffamWd hYdraulktest <br />~Searthed far seeping In yard <br />p Chedted forpads-uP In home <br />O Cave Pig m sot! system/C1-tioxe~ <br />~onieawnar ~tlmorry <br />O F~mmtned for surging to rink <br />O "Black sdY. a0ove soil system <br />q pC'Ier <br />1lQttLca{ Separatlon Distance <br />ConduRetl Boll bortngs , _ /,/ <br />Depth tp Ilmitlng layer. ~i ° ,} „j. <br />Depth to system bottom .~z`~ <br />a t~mined records <br />o -lGi! umiCnglayervertflcatfon~ ' <br />o . other - <br />Status4itfie system _ <br />•"' • eck one) [7 tatting (m r groundwater) O an <br />8asetl an the compliance criteria, trio system status Is. <br />Imm{neat threat tu•pubitc healGi or safety (I7PHS), !? non P{rant (mon{toting ISsve) comp{rant (aerie of the 3 <br />previous corlditlerts}, Therefore, this:dotvment is a: - ltificate Of CArnpilance D NDtice of Nonwmpllanae , <br />Ys this system an EPA t:lats V Injection Weil? D ~ ne <br />~erti ration ran ar t3PSlgner I or Qualified Employee UuPedar and/or QuaQtiett Employ <br />i hereby cetCly as a sots of Minnesota licensed Inspecto d/ m and that m retrordsd <br />DeAgner i that I conducted an invetttgatlon that atturately detpmined the compYance status of Gtts sys0e Y <br />unkn~ormnocon~tlonaOuAng syscern oansevetion,nnabuse of Cis system, In de9uate~main~tanancee ar~ re water usage. a duo bo <br />Inspecto(s name (print) ~~ n r'd' ~ ~}• (`~~~ Phan•,~ & 3 - 7 8'7~ 7 ~ ~ ~ b'90 ~ <br />license and(or tlori Number ~ ~~ address. PO l3 o~L 3 <br />employee pY ~~t~S w4 ~ i 9a'~bdress ~~!•~ ~ 110 rY1 H S.S3 ~ ~. <br />~ Date t/-11~~ <br />slgnatvre <br />'~[poiadB.AesLirrr~rents rotmrhedramMaart~vs@tuteslflS.S3J <br />•Rn IJPN~mu# bs upgradau; ar la use c~nCl+rnd w/a7ki tere mon4ht afns:e/pt c/rfr/s noatr rX rrtth/n a ,thorRYpr~ ~` <br />requaa+t br,tor~a! aroprarlce: If drs systtsrr+ fads [b prpvlda suAFdeorgnxmdwaltYpro[ecoaL the'+ the s)nye~++ mustba upg~ade<Q, . <br />/~Cd, orrtr use disaon07rrxd ndb5/n die f/me iequard b)'/t/k ar the locJ/ oro0d+ant+e~ If an /t4 system >s,rer$~as ainllhed Hr <br />hw,,~ndl.IaraCl~l-ro.A~t~radergyq•,~bA'agaaraabll. didr Dhesystarnncednor6e t~graeseQ tepA/~, n7~ or2suse <br />dlsecndnued, m~9 anyPor2f old/nancr aratfstt7at? srikt 77tds abet not appy lt7 systa~ns /n slroieAand arsaz~ weA'head <br />~?~'Q!!?!~ 4r d14~ wrd Ih connaetdw- w/(h fob devasrayG and kdg/nQ extbb/ishments as dr1lnad hr /aw. <br />&uaae~ d Attachments <br />i} Sltp,iggosl cqukl.also lndude: we0, well setback to system, dwelling of otlter buildings, tank(;),reserved soil trratment area, <br />• Sulfate rratarand saltboring'tocanans: :nCUde as-bulR drawla8 it awilabie. <br />z} ° Stn pannytogar~ Atowtng each horizon. Indicate the texture, color. redvnimorphlc features debth to 4edroct4 stance =water and <br />whether d1a mstMal is fill. <br />3) A ustof any and a0 requirements of Cie lecsl orglnance that are dl{Yefent from the state riiqulrements referred to on ifs (orn1. <br />9) A homeowner survey of system performance, slgMed by the~iomc9wrter as betn~g'facttat. Y - • . <br />S) Mapltorfig data as appropriate. .,~. <br />• Pa§e Z of'2 ~ ,~ <br />