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Property address: 2600 Thoroughbred Lane,Orono,MN Inspector initials/Date: .J.0.4/21/16 <br /> I. Impact on Public Health—Compliance component#1 of 5 <br /> Compliance criteria: _ Verification method(s): <br /> System discharge sewage to the I ❑Yes ®No ® Searched for surface outlet <br /> .ground surface.._ _- Searched for seeping in yard/backup in home <br /> System discharge sewage to drain file ; ❑Yes No <br /> Excessive ponding in soil systemlD-boxes <br /> or surface waters. ❑ Homeowner testimony(See CommentslExplanation) <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 CommentslExplanation) <br /> an Imminent Threat to Public Health and Safety. ❑ Other methods not listed(See CommerltsEKplanation) <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,dryweil,or leaching pit. El Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank integrity Form(Attach) <br /> compliant if allowed in local ordinance <br /> - - _ - - ❑ Observed liquid level below operating depth <br /> Sewage tank(s)leak below their <br /> ❑Yes ®Noo <br /> designed operatt_"ng depth. j ❑ Examined empty(pumped)tanks(s) <br /> -' ❑ Probed outside tank(s)for"black soil" <br /> If yes,which sewage tank(s)leaks: <br /> -- - ❑ Unable to verify(See CommentsiExplanation) <br /> Any"yes"'answer above indicates the ®Other methods not listed(See CommentslExplanation) <br /> system is Failing to Protect Groundwater. <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 ❑Unknown <br /> b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. O Yes` S No ❑Unknown <br /> *System is an imminent threat to public health and safety <br /> Explain: <br /> i <br /> c. System is non-protective of groundwater for other conditions as determined by inspector Q 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 alternative formats <br /> wq•wwfsts4-31 - 1124112 Pane 2 of 3 <br />