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Aug 12 14 06:15p Joseph Olson 763-498-8290 p.3 <br /> Property address: 3065 Watertown Road,Orono,MN Inspector initials/Date: J.0.06/25/14 <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 fior seeping in yardlbackup in home <br /> System discharge sewage to drain tile ❑Yes ®No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. ❑ Homeowner testimony(See CommentalExplanation) <br /> ❑ "Black soil"above soil dispersal system <br /> System cause sewage backup into ❑Yes ® No ❑ System requires`emergency'pumping <br /> dwelling or establishment. ❑ Performed dye test <br /> Any"yes"answer above indicates the system is ❑ Unable to verify(See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. ❑ Other methods not listed(See Comments/Explanation) <br /> CDmments/Exp lanation: <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,drywell, or leaching pit. ® Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Form(Attach) <br /> compliant if Mowed in kv.W ordinance. <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s)leak below their [:]Yes 0 No ❑ Examined empty(pumped)tanks(s) <br /> designed operating geoh. <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for`black soil" <br /> Any "yes"answer above indicates the ❑ Unable to verify(See CommenWExplanation) <br /> system is Failing to Protect Groundwater. El Other methods not fisted(See CommentslExplanation) <br /> CommentslExp lanation: <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. ❑Yes• ® No ❑Unknown <br /> `System/s an immirrent 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 /> '"tem is fairing to protect groundwater <br /> Explain: <br /> www.pca.state.mn.us - 651.296-6300 - 800.657-38(A TTY 651-282-5332 or 800-657-3864 - Available in altemative formats <br /> wq-ww1sts4-3f - 1124/12 Page 2 of 3 <br />