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Property address: 225 Old Crystal Bay Road S., Orono,MN Inspector initials/Date; J.0. 7/20/18 <br /> 1. Impact on Public Health—Compliance component#1 of 5 <br /> Compliance criteria: Verification method(s): <br /> System discharge sewage to the 0 Yes ® No ® Searched for surface outlet <br /> ground surface. ® Searched for seeping in yard/backup in home <br /> System discharge sewage to drain tile , 0 Yes ®No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. ❑ Homeowner testimony(See CommentsIExplanat'on) <br /> ❑ "Black soil'above soil dispersal system <br /> System cause sewage backup into ❑Yes ®No <br /> dwelling or establishment. ❑ System requires"emergency"pumping <br /> ❑ Performed dye test <br /> Any"yes"answer above indicates the system is 0 Unable to verify(See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. 0 Other methods not listed (See Comments/Explanation) <br /> Comments/Explanation: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Compliance criteria:riteria: Verification method(s): <br /> System consists of a seepage pit, 0 Yes X4 No ® Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. ►I4 Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Form(Attach) <br /> compliant if allowed in local ordinance. <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s) leak below their 0 Yes ® No ❑ Examined empty(pumped)tanks(s) <br /> designed operating depth. <br /> If yes,which sewage tank(s) leaks: ❑ Probed outside tank(s)for"black soil' <br /> Any "yes"answer above indicates the ❑ Unable to verify(See Comments/Explanation) <br /> system is Failing to Protect Groundwater. 0 Other methods not listed(See Comments/Explanation) <br /> Comments/Explanation: <br /> The tanks are to be abandoned. <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. El Yes* ®No ❑Unknown <br /> b. Other issues(electrical hazards.etc.)to immediately and adversely impact public health or safety. 0 Yes* No El Unknown <br /> *System is an imminent threat to public health and safety <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector ❑Yes" Ci No <br /> *System is failing to protect groundwater <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • 1/24/12 page 2 of 3 <br />