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Nov 12 2015 09:27PM HP FaxRusty Olson 7634988290 page 17 <br /> � , . <br /> Property address: 2990 Somerset Lane, Orono,MN Inspector initialslDete: J.o. 10/30/15 <br /> 1. Impa�t on Public Health—Cornpliance component#1 of 5 <br /> Compliance criteria: Verification method(s): <br /> System discharge sewage to the j ❑Yes �No � Searched for surface outlet <br /> ground surface. _ ___ t � Searched fvr seeping in yardlbadcup in horne <br /> System discharge sewage to drain tile ' ❑Yes �No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. � ❑ Homeowner testimony(Sea CommentsrExplanatron) <br /> ❑ "Black soil"abvve soil dispersal system <br /> System cause sewage backup into ❑Yes �No ❑ System requires"emergency'pumping <br /> dwelling or establishment. � <br /> ❑ Performed dye iest <br /> Any"yes"answer above indicates the system is p Unable to verfiy(see comrrrentsiExp�anation) <br /> an/mminerit Threat to Public Health and Safefy. ❑ Other methods not listed(See Commenta/Exp/anat;on) <br /> Com ments/Expla nation: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Compliance criterla: _ 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 /> SeepagB pitsmeetirrg7U80.2550maybe i ❑ Examined 7ank Integrity Form(Atfach) <br /> co iant if allowed in local o�inance. <br /> ; ❑ Observed liquid level below operadng depth <br /> Sewage tank(s) leak below their ❑Yes � No � Examined empty(pumped)tanks(s) <br /> designed operatin depth. ; <br /> If yes,which sewage tank(s)leaks ❑ Probed outside tank(s)for"black sal" <br /> ❑ Unable t0 verify(Sea Comments/Explanation) <br /> Any"yes"answer above indfcates the �pther methods not listed (Sea Comments�xplanatioa) <br /> system is Failing to Protect Groundwater. <br /> Co m m e ntslExpla nation: <br /> 3. Other COmplianCe GOnditiOrts —Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsewred,or�pear to sVucturally unsound. ❑Yes` �No ❑Unknown <br /> b. Other issues(e►ectricaJ heaerds,etc.�to immediately and adversely impact public health or safety. p Yes` �No ❑unknown <br /> ''Sysi�em�s an lmminent tBreat to publfc health and safety <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determirred by inspectar ❑Yes• �No <br /> "System Is failing to protect groundweter <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • B00-657•3864 • TTY 651•2ffi•5332 or 800-657-3864 • Available in altemative formats <br /> wq-wwists9-31 . f/24!11 Poge 2 of 3 <br />