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HomeMy WebLinkAbout0002w. ._��aT4�.`fL.� WaTa�.i "nm`A1iN'C. F • ,.cN'!T'"Y'.VIT . `v���f J YL .s. y� .. Y��+Yit ` �[(�'� • ^ "!MF'.e �"TJl^N II "SLR -' ^. '...��..� Septic Evaluation Inc. 13945 Anderson Lakes Pkwy 9317, Eden Prairie, MN 55344 - DATE DATE OF INSPECTION: I I- I L , TIME::.. 1 0 0 - WEATHER _ REASON FOR INSPECTION IDEI ^1TIFICAT10N • Bedroom addition: Pro} erty Owner ❑variance Site Address ygan AAa#- I-)Wah Sf City iJ LC �JC • Complaint Zip Code County - `,Property Transfer Phone ( ) Fire No. ❑.Other Mara &N ,qQ q SYSTEM Issystemopenedup? Y© Full Partial Hastmk(s))eeyyerboonpumped ?© N Yearsystemwasbuilt � ❑basementbackup ❑ sluggish ❑ How often was tank pumped? 2 For xinatreasm ?Al, cantina plumbing When N Wha r By Any repair done to the system? . 17`'15 Usage: ❑ Dwelling 0 Other an t ❑ Seasoa t No. Bedrooms Wawusingapplianxs: ❑Clothe Washa DDishaxshaO tdnge Dispoa 0%.11poolbath DWawCorhticca OSeifaleaninghunddifierinfurnace 1. i Nearest. Surface : Water; = n lmmiduchtypeofsurface %%ter ❑ river : ❑lake ❑sveam ❑other Check appropriates,,, system mmpmem and indicate location on sketch on back of form, Tank (s) Tankls)Material Soil Treatment System Other I Septic tank ❑ fiberglass rock trench ❑ alternative sys m ❑acmbnc tank. %gm ahambu 0expa point system �t'�c C3 pump tank trench . D holding tank. O � Yp mocrnr Cl seepage hod � doper ❑monad - F ❑ at -grade Tauk(s) Pl. sodtxzm tareasiws) sgft. COMPLIANCE INSPECTION " Is there or has there ever ban any evidence of, Response Discharge of sexxge to the ground surface? YES Discharge to the surface vver? YES N of sewage Aseepage pit, dryvvell, cesspool, or leaching pit? O 7 C -1zt� L © Less than three fat of ver separation bet%= the wit treatment � j syste bottom and saturated soil, mottling or bedrock? YES Same backup into the dweging a other establishment? YES I. i Situation with the potential to immediately and adversely impact or threaten public health or safely? YES N iCYES was answered for any of the above questions. the system is failing according to Minn. R. ch. 7080.0060. I STATUS OF THE SYSTEM /1 1, ( conducted above the system status is 'rat-" y 1' •(L al Based on the compliance inspection house (c lima OR failing j ,t ' AA✓)i��M /V ac e , therefore, the document is a t� /Q - p uI � ! CERTIFICATION T hereby eertify'.asa Min t Designorl). dmtmyobs— auoasrecordedmthisformareaccurateasoftnedatea form far the site stated above. No detemdnation offuturc hydmutic patonnance can be made due to unkumm conditions during systan construction, . future xata usage ova the life of the system, abuse of the system,andtor nnadatuate mainteamoo all of which will adv,uh. affect the life ofthe systan. Inspector's name elomeEkebak Phoned (6 -2484 pJ (MPCA) Minn. Lin. k 890 i inspector's. Signat � 1 `y �1 "� � ""K " 8 Date