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Mar 28 2017 1022AM HP FaxRusty Olson 7634988290 page 3 <br /> Property address: 1805 Sixth Ave. N.,Orono,MN Inspector initials/Date: J.O.3/20/17 <br /> 1. lmpatt on Public Health—Cornpliance component#1 of 5 <br /> Compliance criteria: Verification method(s}: <br /> System discharge sewage to the ❑Yes � No � ��hed for surface ouilet <br /> ground surfacs. � Sparched for seeping in yard/badcup in home <br /> System dischar'ee sewage to drain tile � ❑Yes � Na <br /> ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. I ❑ Hameowner testimony(See CommentsiExp/anetion) <br /> Sysfem cause sewepe backup iMo ❑Yes �No � 'Bladc soil'above soil dispersal system <br /> dwelling or establishmeM. ❑ Syatem requires emergency'pumping <br /> Any"yea"answer above ind/cates!he system is � Pertortned dye test <br /> ❑ Unable to veriFy(see Comments/Ezplanation) <br /> an lmminenf Threat to Public Health and Safety. ❑ Other rnethods not listed(See Comments/Explanatron) <br /> CommentafE�lana0on: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Com liance crit�ria: Verificatlon method(a): <br /> Sysiem consists of a seepage pit, ❑Yes �No ❑ Prabed tank(s�botiom <br /> cesspool, drywell,or leaching pit. <br /> ❑ Examined construction records <br /> Seepage pits meeting 7080.2550 msy be ❑ Exarnined Tank Irrtegrity Form(Attaach) <br /> corn liant i�a!lowed M bcal ordinanoe. <br /> Sewage tank(s)leak below their ❑Yes �No � Observed liquid level belo�v operating depth <br /> desi r�ed o eratin de ih. ❑ Exarnined empty(pumped}tanks(s} <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"bladc soil" <br /> Any"yes"answer above indlcates the ❑ Unable to veriry(See Comments/�cplanat;on) <br /> system Is Failing i�o Protect Groundwater. ��her methods not listed(See Comments�cpranaSon) <br /> CommentslExpla natbn: <br /> Elmer J. Peterson Company pumped the tanks <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenance hole oovers are damaged,cradced,unsecurEd,or appear ta strt�ctutaay unsound. ❑Yes• �No ❑ Unknown <br /> b. Other issues(e/ect�ical hezards,ecc.)to immediately end adversely impact public h�lth or safety, p Yes` �Na ❑unknown <br /> '"SysKem 1s an imminent threat to publfc haaltb and safety <br /> Expiain: <br /> c. System is non-protective of ground water far other conditions as detemvned by inspector ❑Yes" �No <br /> 'Syst�em is iafling to prolectgroundwnter <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 tormats <br /> wq•ww�sts4-31 • 1/24/12 Page 2 of 3 <br />