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Jun 28 2015 10:13AM HP FaxRusty Olson 7634988290 page 3 <br /> Property address: 1180 Townline Road., Orono,MN Inspector initials/Date: J- 0.6/28/15 <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 /> ground surface. ® Searched for seeping in yard/backup 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 Comments/Expianation) <br /> ❑ "Slack soil"above soil dispersal system <br /> System cause sewage backup into ❑Yes ® No " <br /> [I System requires emergency"pumping <br /> dwelling or establishment. <br /> E] Performed dye test <br /> Any"yes"answer above indicates the system is <br /> ❑ Unable to verify(See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. ❑ Other methods not listed(See Comments/Explenetion) <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(&)bottom <br /> cesspool, drywell,or leaching pit. I ❑ Examined construction records <br /> Seepage pits meeting 7080.2550 may be I ❑ Examined Tank Integrity Form(Attach) <br /> compliant if aAowed in local ordinance. <br /> Sewage tank(s)leak below their []Yes ❑ No � Observed liquid level below operating depth <br /> ❑ Examined empty(pumped)tanks(s) <br /> designed operating depth. <br /> If yes,which sewage tank(s)leaks: <br /> El outside tanks) for"black soil" <br /> ® Unable to verify(See CommentslExplanation) <br /> Any "yes"answer above indicates the <br /> system is Failing to Protect Groundwater. ❑Other methods not listed(See Comments/Explanation) <br /> Comments/Explanation: <br /> The tanks were not pumped <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(e/ecbical hazards,etc.)to immediately and adversely impact public health or safety. []Yes* ®No ❑Unknown <br /> System is an imminent threat to public health and safety <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector ❑Yes' ®No <br /> 'System is falling to protect groundwater <br /> Explain: <br /> www.pca.state.mn.us • 651.296.6300 • 800.657.3864 TfY 651.282.5332 or 800-657-3864 . Available in alternative formats <br /> wq-ww1sts4-31 . 1124112 Page 2 of 3 <br />