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Jun 07 2016 07:49AM HP FaxRusty Olson 7634988290 page 12 <br /> / � .. <br /> Property address: 2879 Farview Lane., Orano,MN Inspector initials/Qate: J Q.5117/16 <br /> 1. II11pdCt on Publt'C Hedlth —Compliance component#1 of 5 <br /> Compliance criteria: Veritication method(s): <br /> System discharge sewage to the � ❑Yes � No � Searched for surface outlet <br /> ground surface. � � Searched tor seeping in yardR�ackup in home <br /> System discharge sewage to drain tile ; ❑Yes � No � Excessive ponding in soil systemlD-boxes <br /> or surtace waters. � ❑ Nomeowner testimony (See Comments✓Exp�anation) <br /> System cause sewage backup intC ❑Yes � No � ��B�ack soiP'abave soil dispersal system <br /> dwelling or establishment. I ❑ System requires"emergency"purnping <br /> — ❑ Performed dye test <br /> Any"yes"answer above indicates the sysfem is ❑ Unable to verify(See CommentslExplanation) <br /> an lmminent Threat to Public Health and Safety. ❑ pther methods not listed (see Comments�xptanatron) <br /> CommentslExplanation: <br /> 2. Td11k Integrity—Compliance component#2 of 5 <br /> Comptiance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑ Yes � No ❑ Probed tank(s)botiom <br /> cesspool,drywell, or leaching pit. � <br /> ❑ Examined construction reco�ds <br /> Sespage pits meeb'ng 7080.2550 may be � ❑ Examined Tank Integrity Fofrn(Attach) <br /> cornpliani rt a!lowed in/ocal ordinance. <br /> ! ❑ Ohserved liquid level below operating depth <br /> 5ewage lank(s)feak below their I ❑Yes �No ❑ Examined empty(pumped)tarks(s) <br /> designed operating depth. � <br /> If yes,which sewage tank(s)leaks' ❑ Probed outside tank{s) for"black soil" <br /> ARy "yes"answer above indicates the ❑ �nable t0 verify(See Comments/Explanation) <br /> system is Failing to Protect Groundwater. �Other methods not listed{See CommenrsiExplanation) <br /> CommentslExpla nation� <br /> Pete�son Company pumped the tanks. <br /> 3. Other COfllplidn�e Conditi0n5 —Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecur�ed,or appear to structurally unsound. ❑Yes" �No � Unknown <br /> b. Other issues(electrical hazards,eta)to immediatefy and adversely impact public health or safety. C Yes* �No ❑ unknown <br /> "System is an imminent threat to publ;c health and safety <br /> Explain: <br /> c. System is non-protective of ground wa?ertor other conditions as determined by inspector ❑Yes` �No <br /> `System is failing to proi�ec[groundwater <br /> Explain: <br /> www.pca.state.mn.us • 651-246•6300 • 800-657-3864 • 7TY 651•282•5332 or 800-657-3864 • Available in alternative formats <br /> wq•wwists4-31 . f/24/f1 Page 1 of 3 <br />