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r <br /> Property address: 2600 Thoroughbred Lane _ Inspector initials/Date: 4/2111 <br /> 1. Impact on Public Health—Compliance component#1 of 5 <br /> Com Hance criteria Veriflcation method(s): <br /> ❑ Searched for surface outlet <br /> System discharge sewage to the f []Yes [INo ❑ Searched for seeping in yard/backup in home <br /> _round surface. ___. __-- ❑ Excessive ponding in soil systerrVD-boxes <br /> System discharge sewage to drain til ❑Yes ❑No ❑ Homeowner tesdmony(See CommenW&Planation) <br /> or surface waters. <br /> ------ ❑ "Blade sol'above soil dispersal system <br /> System cause sewage badwp into ❑Yes ❑No ❑ System requires"emergency'pumping <br /> -dwelling orestabliishmwd. ❑ Performed dye test <br /> Any"yes"answer above Indicates the System is ❑ Unable to verify(See CommantsExPlanation) <br /> an Imminent Threat to PubNe Health and Safety. ❑ Other methods not listed(See Com7*nls/ExP18n0tlon) <br /> Comments(Explanation: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> _C_om_pNanca criteria VerMcation method(s): <br /> . <br /> System consists of a seepage pit, f ❑Yes No [I Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. ❑ Examined constriction records <br /> Seepage pits meeting 7080-2&W may be {] Examined Tank Integrity Fort(Attach) <br /> ant li allowed in local DRUMM ._ ���--._ ❑ Observed liquid level below operating depth <br /> Sewage tank(s)leak below their ❑� Yes ®No ® Examined empty(pumped)tanks(s) <br /> designed operating depth. -- C1 Probed outside tank(s)for'black sol" <br /> If yes,which sewage tank(s)leaks: ❑ Unable to verify(See Corwents/Exp/anagon) <br /> Any"yes"answer above inc0cates the ❑Other methods not listed(See CommerttvExplanahon) <br /> system is Failing to Protect Groundwater- <br /> CommentsfExplanation: <br /> On 4/21 MO,Elmer J.Peterson Co.pumped septic 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 p Unwmn <br /> b. Other issues WocirikW hazards,00 to imrim"81y and adversely Impact public health or safety. p Yes" ❑No D UMmown <br /> "System is an fmrrdnent threat to public heaft and satiety <br /> Expla h: <br /> Q System is non-protective of ground water for other conditions as determined by inspector ❑Yes' ❑No <br /> •System is fail/ng lo pmhvct 0roundwatar <br /> Explain: <br /> 651-2% 800.657 <br /> -6300 • -3864 M 651-282-5332 orBW-657.3864 Av <br /> www,pu.state.mn.tws • —�. — � aitabte In altemauve formats <br /> wq-wwists4.31 • 1124111 Page 2 of 3 <br />