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Nov 0714 10:47a Joseph Olson 763-498-8290 p.3 <br /> w Property address: 3220 Watertown Road,Orono,MN Inspector initiafs/Date: J.O.11/06/14 <br /> 1. Impact on Public Health—Compliance oomponerrt#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 yard/backup in home <br /> System discharge sewage to drain We ❑Yes ®No ❑ Excessive ponding in soil systeml0-boxes <br /> or surface waters. ❑ Homeowner testimony(See CommeriWaplanation) <br /> ❑ Tiack soil'above soil dispersal system <br /> System cause sewage backup into ❑Yes ®No <br /> dwelling or establishment. [I System requires"emergency"pumping <br /> C] Performed dye test <br /> Any"yes"answer above indicates the system is <br /> an Imminent Threat t0 Pub/ic Health and Safety. ❑ Unable to verify(See Comrnentsllwxplanaffon) <br /> ❑ Other methods not listed(See CommentslExplanation) <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,drywell,or leaching pit. ® Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Form(Attach) <br /> compliant if eftNed in local ordinance. <br /> ❑ Observed liquid level below operating depth <br /> Sewage ta*s)leak below their []Yes ®No ® Examined empty(pumped)tanks(s) <br /> des' red olLerating depth. <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil" <br /> Any`fires"answer above indicates the ❑ Unable to verify(See Commen&ajoraneflon) <br /> system is Failing to Protect Groundwater. ❑ Other methods not listed(See Comn*nts(Expl9nadon) <br /> Com ments/Explanation: <br /> Alben Septic Service pumped the tanks <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cradred, unsecured,or appear to structurally unsound. ❑Yes` O No []Unknown <br /> b. Other issues(electrical t etc.)to immediately and adversely impact public health or safety. []Yes* O 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 failing to protect groundwater <br /> Explain: <br /> www.pcastate.mn.us - 651-296-6300 - 800457-3864 TTY 651-2112-5332 or 800-657.3864 - Avaitable in aitemative formats <br /> wq-wwists4 3f . 1124112 Page 2 of 3 <br />