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Aug 0512 08:09p Joseph Olson 763-498-8290 p.3 <br /> Property address: 97U Crystai Creek Road.,Orono, MN fnspector initials/Date: J. O.8/05/12 <br /> 1. Imp�ct on Public Heaith-Compliance oompo�ent#1 of 5 <br /> Com liance criteria: Verification rnethod(s): <br /> System discharge sewage to ihe ❑ Yes �No � Searched for surface oudet <br /> round surtace. � Searched for seeping in yardlE�ackup in horne <br /> 5ystern discharge sewage to drain tile ❑Yes � No � ��sive ponding in soil systemlD-boxes <br /> or surface waters. ❑ Homeowner testimony(See CommentsiExplanafion) <br /> System cause sewage backup in�o �Yes � No � B��soil"above soil dispersal system <br /> dwelling or establishment. ❑ System requires"emergenc�' pumping <br /> ❑ Performed dye test <br /> Arty"yes"answer above irrdicates the sysfem is ❑ Urtable lo verify (Ses Comments/Exp/anation) <br /> an/mminent Threat to Public Health and Safety. ❑ Oiher methods not listed (See CommentsiExplanation) <br /> Comments/Explanation: <br /> 2. Tank Integrity—ComPliance component#2 of 5 <br /> Corr�pliance criteria: Verification method(s): <br /> � <br /> System consists of a seepage pit, �]Yes �No ❑ Probed tank(s)bottom <br /> cesspool,drywell,or leac�ing pit. ❑ ExamiRed construction recards <br /> Seepage pifs meeting 7080.2550 rnay be Q Examined Tank Integrity�omt(Attach) <br /> com liant i�allowad in local arlinartce. <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s) leak below their �Yes �No <br /> desi ned o ratin de th_ � Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(sj for"black soil° <br /> Any "yes"answer above indicates the � U�able to verify(See Cornmenls�cplanation) <br /> system is FaiJing to Protect Groundwater. ��ther methods not listed (Sse Commen�slExpfanation) <br /> C o m m en ts/�xpl a n atio n: <br /> Elmer J Pelecson pumped fhe tanks on 8101/12 <br /> 3. Other'Compl3a�Ce Co�dit1o115—Compliance component#3 of 5 <br /> a. Maintenance hole covers are darnaged,cracked,unsecured, �r appear to structurally unsound. ❑Yes" �{No p Unknowr <br /> b_ Other issues(e�ectrica!i►azar�s,eic.)lo�mmediately and adversey impact public health or safety. ❑Yes• �No ❑Unknown <br /> "'System is aR imminerrt threat to pubJic bealth and safety <br /> E�lain: <br /> c. System is non-protective of ground water for oiher conditions as determined by inspeclor ❑Yes" �No <br /> `SysiBm is failing to protecl groundwater <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 600-657-3864 • TTY 65t-282-5332 or 800-657-3864 • Available in attemative formats <br />