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Feb 22, 2016 04:35PM HP FaxRusty Olson 7634988290 page 3 <br /> „�. . �a .y���#9 1�p� <br /> �. .. �.� } �`k� <br /> ���,�'�� <br /> Property address: 2811 Fairview Lane, Orono, MN _ Inspector initials/Date: J. 0.2/20I16 <br /> 1. IrnpdCt On Publ1C Health—Compliance component#1 of 5 <br /> Compliance criteria: _ Verification method(s): <br /> System discharge sewage to the ; ❑Yes � No � Searched for surface outlet <br /> �round surface. � Searched for seeping in yard/backup in home <br /> System discharge sewage to drain tile �I ❑Yes � No <br /> ❑ Excessive ponding in soil system/D-boxes <br /> or surtace waters. ❑ Homeowner testimony (See Comments�xplanat�on) <br /> S stem cause sewa e backu into ❑ 'Black sail"above soil dispersal sysiem <br /> y g p � ❑Yes � No <br /> dwelling or establishment. ❑ System requires"emergency"pumping <br /> Any"yes"answer above indicates the system is � Performed dye test <br /> an/mminent Threat to Public Health and Safety. ❑ Unable to verify(Sea Comments�xp�anation) <br /> _ ❑ Other methods not listed(See CommentsiExplanation) <br /> CommentslExplanation: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Compliance criteria: Verification method(s): <br /> -T-- <br /> System consists of a seepage pii, � �Yes � No ❑ Probed tank(s)hottom <br /> cesspool,drywell,or teaching pit. �, <br /> r] Examined construction records <br /> Seepage pits meeting 7080.255D may be � ❑ Examined Tank Integrity Form(Attach� <br /> complianf if aJlowed rn loca!ordinance. <br /> Sewage tank(s)leak beiow their I []Y Se�Np � Observed liquid�evel below operating depth <br /> designed operating depth. ❑ E�camined empty(pumped)tanks(s} <br /> If yes,which sewage tank(s)leaks: I ❑ Probed outside tank(s)for"black soil" <br /> AI?y "yes"answer above indicates fhe ❑ Unabie to verify(See Comments/Explanation) <br /> system is Failing to Protect Groundwater. �Other methods not listed (See Comments/ExplanationJ <br /> CommentslExplanation: <br /> Peterson Company pumped the tanks <br /> 3. Other ComplidnCe Condltions—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,crackea,unsecured,or appear to struc�urally unsound. Ci Yes' �No ❑ Unknewn <br /> b. Other issues(electrical hazards,ero.)to immediately and adversely impact public heatth or safety. ❑ves" � No p Unknown <br /> `System is an imminent threat to pubJic healfh andsafety <br /> Explain: <br /> c. System is non-protective of ground water tor other conditions as determined by inspector C Yes• �No <br /> 'System rs failing to protect groundrvatier <br /> Explain: <br /> MnNw.pca.state.mn.us • 651-296-6300 • 800-b57-38b4 . TTY 651-282-5332 or 800-657-3864 • Available in alterna[ive formats <br /> wq•wwists4-31 . 1/24l f2 Page 2 of 3 <br />