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Property address: 485 Tundham Road Inspector initielsOate: 525! _.. <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 yardfiackup In home <br /> — ---�� ❑ Excessive ponding in soft systernJO-boxes <br /> System discharge sewage to drain file I ❑Yes ❑No [:1 Homeowner testimony(See Comrtlerr�Expiarrafion) <br /> or surface waters.._- - _ <br /> _ ----__.—. ❑ 'Black sok"above soil diepersal system <br /> System cause sewage backup into ❑Yes ❑No ❑ System recluires•emos ,.y pumping <br /> dweling or establishment. _ <br /> _-.— ❑ Performed dye test <br /> Any"yes"answer above indketes the system is ❑ Unable to verify(See ConvrrenftE rpranatlan) <br /> an Imminent Threat to Publk Health and Safety. ❑ Other methods not listed(See comm r&,E rptanaaon) <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 ON. ❑ Probed tank(s)bottom <br /> cesspool,drywei,or leaching pit. ` ❑ Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Foran(Attach) <br /> M a6fowed a�rocs!ardblence. — ___._ ❑ Observed liquid level below operating depth <br /> Sewage tank(s)leak below their ❑Yes ®No ® Examined amply(pumped)tanks(s) <br /> —desig!rsd.gx___ __P......_. _____..._..____...-.---.------ ❑ Probed outside tank(s)for Uedk sac" <br /> If yes,which sewage tank(s)leaks: <br /> Any`yes"answer above indicates the ❑ unable to verily(sae Cd(Serrts&wnertalion) <br /> system is Failing to Protect Groundwater. ❑Outer methods not fisted(sae t:anxrrentslFxpiarwlion) <br /> Comments/Explanation: <br /> On 525/18,Elmer J.Peterson Co.pumped tanks. <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. McWenarlce hole covers are damaged,cracked,unftcksed,or appear to structurally unsound. ❑vas• ❑No ❑Urkn wn <br /> b. Other issues(ebra"haaards,alk.)to irmwdmt*and adversely impact pubic health or safety. ❑Yes• ❑No ❑Unknown <br /> 'Sysunr is an MrrW wtr trireat tlo puW ho Mr and osAW <br /> Explain: <br /> a System is non-protective of ground water for other otxrditiona as determined by inspector ❑Yee• 0 No <br /> 'System is Wft tb pvo/eot groun"Wer <br /> Explain: <br /> www.pca.state.mn.us • 651.296-63110 8DD•657.3864 TTY 651.282-5332 or s00-657.38frk Available in altemative formats <br /> wq-ww1sts4-31 • 1/24112 P"r 2 of 3 <br /> I <br />