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Nov 11 2016 09:10AM HP FaxRusty Olson 7634988290 page 12 <br /> Property address: 1045 Brown Road S.,Orono,MN _ Inspector initials/�ate: J. Q 10/26/16 <br /> 1. Impact on Publi� Health—Compliance component#1 of 5 <br /> Compliance criteria: _ Yerification method(s): <br /> 5ystem discharge sewage to the ❑Yes �No � Searched for surface outlet <br /> ground surface. I � Searched for seeping in yardlbackup in horne <br /> System discharge sewage to drain tile � ❑Yes �No ❑ Excessive ponding in soil system/D-boxes <br /> or surfaCe waters. I ❑ Homeowner testimony(See Comrnents/Ezplanatron) <br /> ❑ "81ack soil"above soil dispersal system <br /> System cause sewage backup into �I ❑Yes � No ❑ System requires"emergency'pumping <br /> dwelling or establishment. ' <br /> ❑ Performed dye test <br /> Any"yes"answe�above indicafes the system is ❑ Unable to verify(See Comments/Explanatron) <br /> an Imminent Threat to Public Heafth and Safety. ❑ Other methods nat listed (see commentsiExpiana6on) <br /> Com ments�Explanation: <br /> 2. Tdflk 111tegf ity—Compliance component#2 of 5 <br /> Compliance criteria: Verification method(s}: <br /> System consists ot a seepage pit, � ❑Yes � No � P�obed tank(s)bottom <br /> cesspool,drywell,or leaching pit. <br /> C Examined construction records <br /> Seepage pits meefing 7080.2550 may be ' ❑ Examined Tank Integrity Form(Attach) <br /> campliant if allowed rn loca/ordinance. � <br /> Sewage tank(s}leak below their �� ❑Yes ,� No � Observed IiGuid level below operating depth <br /> desi ned o eratin de th. ❑ Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks; I ❑ Probed outside tank(s)for"black soil" <br /> — ❑ Unable io venfy(See CommentsiExplanation) <br /> Any "yes"answer above indicates the <br /> system is Failing fo Protect Groundwater. �Other methods not listed (See CommentslExplanation) <br /> Cornments/Explanation: <br /> Peterson Company pumped the tanks. <br /> 3. Other COmplidnCe CO�ditio�s —Compliance camponent#3 of 5 <br /> a. Mainienance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes' �No ❑unknown <br /> b. Other issues(erecnrcal hezards,e�c.)to immediately and adversely impact public health or safety. ❑ves� � No ❑unknown <br /> *System is an imminent threat io public health and safefy <br /> Explain: <br /> c. Sys?em is non-protective of ground water for other conditions as determined by inspector ❑Yes' �nto <br /> 'System is failing co protect groundwater <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • B00•657-3864 • TT`(651-282•5332 or 800-657-3864 . Available in altemative formats <br /> wq-wwists4-31 . 1/24!f2 Poge 2 of d <br />