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Oct 21 14 07:05p Joseph Olson 763-498-8290 p.3 <br /> Property address: 4565 Bayside Road,Qrono,MN Inspector initiaJs/Daie: J. �.9/17/14 <br /> 1, IlllpaCt o�1 PUbI�C Hedlth—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 suriace. � Searched for seeping in yardlbadcup in home <br /> System discharge sewage to drain dle ❑Yes Q�iVo � �cessive ponding in soil systemlD-boxes <br /> or surface waters. ❑ Homeowner testimony(See Comments�lExplanatron) <br /> (] "Black soil"above soil dispersal system <br /> Systern cause sewage backu�into ❑Yes �No ❑ System requires'emergency"pumping <br /> dwelling orestablishment. <br /> ❑ Performed dye test <br /> Any"yes"answer above indicates the system is [] Unable to verify(See Commentsl6rplanation} <br /> an lmminent T�rreaf fo PubJfc Hea/th and Safety. ❑ pther methods not listed(See CommentsiE�cplanation) <br /> CommentslExpfa nation: <br /> 2. Tank Integrity—Cornpliar�ce component#2 of 5 <br /> Compliance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑Yes �No I� Probed tank(s)bottom <br /> cesspool,drytivell,or leaching pit. <br /> � �camined construction records <br /> Seepage pits meeiing 7080.2550 may be '� ❑ �camined Tank lntegrity Form(Attach� <br /> compliant if aAowed in loca!prdinance, <br /> Sewage tank(s}leak below their ❑ Yes � No � Observed fiquid level below operating depth <br /> designed operating depth. ❑ Examined empty(pumped)tanks(s) <br /> — - -- <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soi�" <br /> �IRy "yeS"anSWel's�bOVe llldiCates t'he ❑ Unable to�er'rfy(See CommentsiExplanation) <br /> sysrem is Farling to Pratect Graundwarer. ❑Oiher methods not listed (See Comments/Exp►anation) <br /> CommentslExplanatio�: <br /> 3. 4ther Compliance Conditions—Compl�ance componer�t#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked, unsecured,or appear to struciurally unsound. ❑Yes" �No ❑Unknown <br /> b. Other issues(elecbicarhazards,erc_)to immediately and adversely impac!pubEic heaith or safety. ❑Yes" Q�No ❑Unknovm <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 dete►mined by inspector ❑Yes` �No <br /> "System is failing to proteci groondwater <br /> Explain: <br /> www.pca.state.mn.us • b51-296-6300 • 800-65T-3864 • TTY 651-282-5332 or SOQ657-3864 • Available in aLternative formats <br /> wq-wwlsts4-31 • t/Z,f/11 Aage 2 of 3 <br />