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Nov 12 2015 09:24PM HP FaxRusty Olson 7634988290 page 3 <br /> Property address: 2995 Deer Run Trait, Orono, Mh _ _ Inspector initials/Date: J. O. 10l30/15 <br /> 1. Impact on Public Heafth-compiiance component#1 of 5 <br /> Compliance criteria: _ Verification method(s): <br /> System discharge sewage to the ❑Yes � No �i Searched for surface outlet <br /> ground surface. � Searched for seeping in yarcUbackup in home <br /> System discharge sewage to drain tile � ❑Yes � No � Excessive ponding in soil system/D-boxes <br /> or surface waters. ❑ Homeowner teslimony (See CommentsiExpJana�ron) <br /> System cause servage backup into �I ❑Yes � No � ��Slack soiP'above soil dispersal system <br /> dwelling or establishment. ! ❑ System requires"emergency'pumping <br /> Any"yes"answer above indicates the system is ❑ PerFormed dye test <br /> ❑ Unable to�enfy(See Comments/Explanafion) <br /> an lmminent Threat to Public Healfh and Safety. ❑ pther methods not listed(See commentsiExplanat�on) <br /> CommentslExplanation: <br /> 2. Tank Integrity—Compiiance component#2 of 5 <br /> Compliance criteria: Verification method(s}_ <br /> System consists of a seepage pit, �❑Yes � No � Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. � Examined construction records <br /> I <br /> Seepage pits meeting 7080_2550 ma�be I ❑ Examined Tank Integrity Form(Attacha <br /> com�ent if ellowed in local ordinance. ; <br /> � ❑ Observed liquid level below operating depth <br /> Sewage tank(s) leak beiow their ❑Yes <br /> designed operating depth. � � No ❑ Exarnined empty(pumped)tanks(s} <br /> If yes,whicn sewage tank(s)leaks: ❑ Probed outside tank(s) for"black soil" <br /> �, „ —" — `- — ❑ Unable to verify(See Comments/Explanat;on) <br /> Any yes answer above indicates the <br /> sysiem is Failing to Proteci Groundwater. ❑Other methods not listed(ses Comments/Exp�anatron) <br /> Com ments/Explanation: <br /> Peterson Company pumped the tanks <br /> 3. Other Compliance Conditions -compiiance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes* �No � Unknown <br /> b. Other issues(electncarhazards,etc.)to immediately and adversely!mpact public health or safety. ❑Yes" �No ] Unknown <br /> "System is an;mminent threaf fo public health and safety <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector ❑Yes• �No <br /> "System is failing to protecf groundwater <br /> Explain: <br /> www.pta.state.mn.us • 651•296-b300 • 800-657•3864 • TTY 651-282-5332 or 800-657-3864 � Avaitable in alternative formats <br /> wq-wwists4-31 • 1l24/12 PQge 2 of 3 <br />