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Jul 11 13 06:45a Joseph Olson 763-498-8290 p.3 <br /> Property address: 1100 Town Line Road,Orono, MN Inspector initials/Date: J.O.7111/13 <br /> 1. Impact on Public Health—Compliance component#1 of 5 <br /> Compliance criteria: Verification method(s): <br /> System discharge sewage to the ❑Yes ® No ® Searched for surface outlet <br /> round surface. ® Searched for seeping in yardibackup in home <br /> System discharge sewage to drain file ❑Yes ®No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. ❑ Homeowner testimony(See CvmmentvExplanation) <br /> System cause sewage backup into ❑Yes ® No ❑ "Black soil'above soil dispersal system <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 Commentsl&pianabon) <br /> an Imminent Threat to Public Health and Safety. ❑ Other methods not listed(See Comments/Explanation) <br /> Comments/Explanation- <br /> 2. <br /> ommentslExplanation: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,drywell,or leaching pit. ® Examined construction records <br /> Seepage pits meeting 7030.2550 may be ❑ Examined Tank Integrity Form(Attach) <br /> compliantYaAowed in tical ordinance. <br /> ❑ Observed liquid level blow operating depth <br /> Sewage tank(s)leak below their i ❑Yes ® No <br /> designed operating depth. ❑ Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: i ❑ Probed outside tank(s)for`black soil` <br /> Any"yes"answer above indicates the El Unable to verify(See Comments�Explanation) <br /> system is Failing to Protect Groundwater. ®Other methods not listed(See Comments/Exptanation) <br /> Comments/Explanation: <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(eiedricai hazards,etc.)to immediately and adversely impact public health or safety. p Yes* ®No ❑Unknown <br /> *System is an imminent threat to public health and safety <br /> Explain: <br /> a System is non-protective of ground water for other conditions as determined by inspector ❑Yes' ®No <br /> *System is failing to protectgmundwater <br /> Explain: <br /> www.pca.state.mn.us • 651-2%-6300 . 800-657-3864 TTY 651-282-5332 or 800-657-3864 - Available in alternative formats <br /> wq-wwists4-31 • 1/24/12 Page 2 of 3 <br />