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Feb 22, 2016 04:35PM HP FaxRusty Olson 7634988290 page 3 <br /> Property address: 2811 Fairview Lane, Orono, MN Inspector initials/pate: J. O.2/20I16 <br /> 1. Impact on Public Health—Compliance component#1 of 5 <br /> Compliance criteria: _ Yerification method(s); <br /> System discharge sewage to tl�e ; ❑Yes � No � Searched for surface ouilet <br /> �ound surface. � Searched for 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 CommentslExplanat�on) <br /> ❑ `Black sail"above soil dispersal syslem <br /> System cause sewage backup into ❑Yes � No � Sysiem requires"emergency"pumping <br /> dwelling or establishment. <br /> Any"yes"answei above indicates the system is � Performed dye test <br /> an lmminent Threat to Public Health and Safety. ❑ Unable to verify(See CommentsiExplanation) <br /> ❑ Other methods not listed(See Commenfs/Explanation) <br /> CommentslExplanation: <br /> 2. Tank Integrity—Compliance component#2 ot 5 <br /> Cem liance criteria: Verificati�n method(s): <br /> System consists of a seepage pii, ❑Yes � No ❑ Probed tank(s)bottom <br /> cesspool,drywell, or�eaching pit. ❑ Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Form(AttachJ <br /> complianf rf allowed in local ordinance. <br /> Sewage tank(s)leak below their ❑Yes �No � Observed liquid ievel below operating depth <br /> designed operating depth. � ❑ Examined ernpty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: i ❑ Probed outside tank(s)for"bfack soil° <br /> Any "yes"answer above indicates the ❑ Unable to verify(See Commenhs/Explanation) <br /> system is Failing to Protect Groundwater. �Other methods not listed(5ee Commenfs/Explan&tion) <br /> Comments/Explanation: <br /> Peterson Company pumped the tanks <br /> 3. Othe� COI'1'1p11dnC2 COnd1t1011S—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecured,or appear to struduraHy unsound. C Yes' �No ❑ Unknown <br /> b. Other issues(e�ectrical hazards,etc.)to immediately and adversely impact public heafth or safety. ❑Yes' �No ❑ Unknowr <br /> "System is an imminent threat to public healfh and safeiy <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector ❑Yes• �No <br /> 'Sysfem is failing to protect groundwai�er <br /> Explain: <br /> Nnvw.pca.state.mn.us • 651-296•6300 • 800-b57-38b4 . TTY 651•282-5332 or800-657-3864 • Available in alternative formats <br /> wq-ww�srsa-.�r . 1124/12 Paqe 2 of 3 <br />