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Nov 11 2016 09:08AM HP FaxRusty Olson 7634988290 page 3 <br /> Property address� _2990 Somerset Lane,Orono MN � Inspectar initialslDate: J.O.1 Qf27/18 <br /> 1. Impact on Pubtic Health—Compliance component#1 of 5 <br /> Ccm liance criteria: Veriflcation method(s): <br /> System discharge sewage to the ❑Yes � No � Searched for surface outlet <br /> _ground surface. _ I � Searched fo�seeping in yardlbackup in home <br /> Sysfem discharge sewage to drain tile ❑Yes � No ❑ �cessive ponding in soil system/D-boxes <br /> orsurface waters. i ❑ Homeownertestimony(See comments/Explanetion) <br /> ❑ "Black soil"above sal dispersal system <br /> 5ystem cause sewage backup into ❑Yes � No ❑ System requires"emergency°pumping <br /> dwelling or establishment. , <br /> ❑ Performed dye test <br /> Any"yas"answer above indlcates the system is ❑ UnBble to verify(See Comments�Explanation) <br /> an Irnminent Threat to Publ;c Health and Safety. p Other methods no1 listed(See CommentsiExplanation) <br /> C om ments/Expla nation: <br /> 2. Tdtlk Int2grity—Compliance component#2 of 5 <br /> Compllance crlteria: Veriflcation mstl�od(s): <br /> System consists of a s�page pit, , ❑Yes �No � P�obed tank(s)bottom <br /> cesspool,drywell,or f�ching pit. ; � Examined construction recrords <br /> 5eepage pits meering 7080.255o may be � ❑ Exarnined Tank Integrity Form(Attach) <br /> complianf if eNowed irt locs!oMinance. I <br /> ❑ Observed liquid leve!below operating depth <br /> 5ewage tank(s)leak below their i ❑Yes �Np <br /> des' ned a ratin de th. ❑ 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 CommenfsiExplanation) <br /> /�/'ly"yes"answer above fndicates fhe �p�er methods not llsted(See GommanfslExpfenefion) <br /> system is Failing to Protect Grourtdwater. <br /> Commer�tslExplan ation: <br /> 3. Other COmpfienCe Conditlons—Compliance component#3 of 5 <br /> e. Maintenance hole covers are damaged,craGced,unsecured,or appear to strudurally unsound.• ❑Yes' �Na p Unknown <br /> b. Other issues(e/echrca�hazerds,etc.)to imrnediately and adversely impad publlc healih or safety. p Ye$" �No ❑ Unkrtawn <br /> "System is an imminent Llrr�sa!to publlc hea/th and safefy <br /> Explain: <br /> c. System is non-protective of ground water for other cpnditions as determined by inspedor ❑Yes• �No <br /> "Sysfem!s iaiNng to p�oteetgroundwater <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 800-657�3864 . TTY 651-262•5332 or 800-657•3864 • Available in altemative formats <br /> wQ•wwists9-31 • �l?4/i2 P�Iof3 <br />