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Property address: 735 Dickey Lake Drive, Orono, MN Inspector initials/Date: J. O. 7/24/18 <br /> 1 . Impact on Public Health —Compliance component#1 of 5 <br /> Compliance criteria: Verification method(s): <br /> System discharge sewage to the ❑ Yes ® No ® Searched for surface outlet <br /> ground surface. ® Searched for seeping in yard/backup in hone <br /> System discharge sewage to drain tile ❑Yes ® No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. ❑ Homeowner testimony(See Comments/Explaratior?r <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 ❑ Unable to verify(See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. <br /> ❑ Other methods not listed (See CommentsrExp ,,; <br /> Comments/Explanation: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Compliance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑ Yes ® No ❑ Probed tank(s) bottom <br /> cesspool, drywell, or leaching pit. ❑ Examined construction records <br /> Seepage pits meeting 7080.2550 maybe ❑ Examined Tank Integrity Form (Attach?) <br /> compliant if allowed in local ordinance. <br /> ❑ Observed liquid level below operating cher tl. <br /> Sewage tank(s) leak below their ❑ Yes No <br /> designed operating depth. ❑ Examined empty(pumped)tanks(s) <br /> If yes, which sewage tank(s) leaks: ❑ Probed outside tank(s)for"black soil' <br /> ❑ Unable to verify(See Comments/Explanatiorri <br /> Any "yes"answer above indicates the <br /> system is Failing to Protect Groundwater. ►=� Other methods not listed (See Comments/Expr, r; <br /> Comments/Explanation: <br /> Peterson Company pumped the tanks. <br /> 3. Other Compliance Conditions —Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes* ®No ❑ :. <br /> b. Other issues(electrical hazards.etc.)to immediately and adversely impact public health or safety. ❑Yes* ®No E <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* ®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 atter?; ;; <br /> wq-wwists4-31 • 1/24/12 <br />