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Apr291410;57a Joseph Olson 763-498-8290 p.3 <br /> Property address: 2010 Colin Drive,Orono, MN _ Inspector initialsfDate' J.O.02J03/14 <br /> 1. ImpdCt on Publie Health—Compiiance cornponeni#1 of 5 <br /> Compliance criteria: _ _ _ Verification method(s): <br /> 5ystem discharge sewage to the ❑ Yes �No � Searched for surface outlet <br /> grour�d surface. � Searched fir seeping in yardlbadcup in home <br /> Sysiem discharge sewage 10 drain tile ❑Yes � No ❑ Excessive ponding in soi!system/D-boxes <br /> or surface waters. ❑ Homeowner testimony(See Comments/Explanation) <br /> � ❑ "81ack soil"above soil dispersal system <br /> System cause sewage backup into I �Yes � t�o <br /> dweiling or establishmenk � ❑ System requires"emergenc�'pumping <br /> ❑ Performed dye test <br /> Any"yes"answer above indicales the system is � Unable to verify(5ee CommerrtslErplanation} <br /> an lmmrnenf Threat to Pu6lic Healfh and Safety. ❑ Other methods no#listed�see Comme�ts�xpranarion) <br /> Com ments/Expl anati on: <br /> 2. Tdnk Integ�ity—Compfiance component#2 of 5 <br /> _Compliance criteria: _ _ Verification method(s): <br /> Sysiem cor�sists of a seepage pit, ; Q Yes � No ❑ Probed tank(s)bottom <br /> cesspool,drywell, or leaching pit. , � F�camined construction records <br /> Seepage pits meeting 7080.2550 may ba � <br /> compJrsnt if allowed rn local ord'mance. � �xamined Tank Integrity Form(Attach) <br /> Sewage tank{s)leak beiow their ❑Yes � No � Obsenred liquid level below operating depth <br /> designed operating de th. ❑ Examined empty(pumped)tanks(s} <br /> If yes,whi�h sewage tank{s)leaks: ❑ Probed outside tank(s)fnr"black soif" <br /> Any "yes"answer abave indicates rhe ❑ Unab€e to verify(See CommentsiExplanationJ <br /> System 15 Fa!liRg to PI'oteCf GrOulldwarBl'. ��her meihods not listed (see CommentsiExplanation) <br /> CommentslExplanation: <br /> Elmer J Peterson pumped ihe tanks on 0'!131114 <br /> 3. Other COrilplid�CC C011d1ti0�5—Compliance compone�k#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecured,or appear io struduralfy unsot�nd. �Yes" �No ❑ Unknown <br /> b. Other issues(elec3nca�hazards,etc.}to immediately and adversely impact public health or safety. p Yes* �No ❑Unknown <br /> `System is an imminenf threat fo public heald�and saiety <br /> Explain: <br /> c. System is non-protecTive of ground water for other conditions as determined by inspedor ❑Yes` � No <br /> *System is failing to protect groundwater <br /> Explain: <br /> www.pca.state.mn,us • 651-2%-6300 • 800-657-3864 . TTY 651-282•5332 or 800-657-3864 • Available in altematiwe formats <br /> wq-wwPsts4-3 i • 1I P4/f 2 Poge Z of 3 <br />