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3575 Christine Dr,Orono MN 55358 <br /> Property address: Michael�Janelle Shields Inspector initiatslDate: LB 10/22/2015 <br /> 1. Impact ott Public Health—Compliance component#1 of 5 <br /> Com Elance criteria: Verifcatlon method(s): <br /> System discharge sewage to the ❑Yes ❑No ❑ Searched for surface aatlet <br /> round surface. ❑ Searched for seeping ln yard/badcup in home <br /> System discharge sewage to drain Gle ❑Yes ❑ No ❑ �sslve ponding 1n soil system/D-boxes <br /> or surface waters. ❑ Homeowner testimony(Sss Commems/Explanatlon) <br /> [] "Bladc soil°above soii dispersal system <br /> System cause sewage backup into ❑Yes ❑ No � gy,tem requires"emergency'pumping <br /> dwelling or establishment. <br /> ❑ Performed dye test <br /> Any"yes"answer above indfcates fhe system Is ❑ Unable to vertfy{see Comments/Explanetior►) <br /> an/mminent 7"hreat to Pub!!c Healfh and Safety. ❑ Other methods not listed(see Comments�cpranation) <br /> Comments/E�lanation: <br /> 2. Tank tntegrity—Compliance component#2 of 5 <br /> Com liance ctiteria: Verffication method(s): <br /> Sysiem consists of a seepage pit, ❑Yes�o ❑ Prabed tank(s)bottom <br /> cesspool,drywell,or leaching pit. <br /> ❑ Examined construction records <br /> Seepsqe�its meeting 7080.2550 may be ❑ Examined Tank Integrity Form(Attach) <br /> oom lant if allowed Tn loce!ordlnartce. <br /> ❑ �bserved liquid leve!below operating depth <br /> Sewage tank(s)lesk below their ❑Yes No <br /> desf ned o ratin de th. � Examined empty(pumpedy fanks(s) <br /> if yes,which sewage tanfc{s}leaks: ❑ Probed outside tank(s)for"black soi!" <br /> Any"yss"answer above fndfcates the ❑ Unable to verify{See Comments/Explanation) <br /> system Is Falling to Protect Groundwater. ❑��►er methods not listed(Sea CommentsiExplanetion) <br /> Comments/Euplanation: �—�e�p 9�.6le,., �c,.,,� 5 n� �o o d C'o,.�d;�o,J <br /> Business Name: Kothrade Sewer,Water,Excavafing, Inc <br /> Business Addr�ess: 12059 Whitetail Ln, Hanover MN 55341 <br /> � Business Phone: 763.498.8702 <br /> Company Representative: Larry Bursch MPCA#: 0192/9t99 Signat � <br /> 3. Other Comp(iance Conditions—Compliance component#3 of 5 <br /> a. Maintenanve hofe covers are damaged,cracked,unsea�red,or appear to struduralty unsound. p Yes` p No p Unknown <br /> b. Other issues(elechicslhazards,eic.)to immediately and adversely impad pubfic heafth or sa#ety. Q Yes• ❑No O Untcnown <br /> 'System Js an/mminenf thne�at to pubiic heaith and safety <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector p Yes• p No <br /> •System is failing to protect groundwater <br /> www.pca.state.mn.us • 65t496-6300 • 800-657-38b4 • T7Y 651•282•5332 or 800•b57-3864 . Avaflable in attemative fortnats <br /> wq-wwists4•3f . !/24/f2 Poge 2 of 4 <br />