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May 24 2015 04:15PM HP FaxRusty Olson 7634988290 page 3 <br /> Property address: 1250 French Creek dnve,Orono, MN ,__ Inspector initialslDate� J. O.5/19/15 <br /> 1. ImPaCt On PUbIiC Hedlth —Compliance component#1 of 5 <br /> Compliance criteria: Verificatian method(s): <br /> _ _. — ---�—. <br /> System discharge sewage to the ❑Yes � No <br /> � Searched for s�rtace outlet <br /> qround surface. I� Searched for seeping in yardlbackup in home <br /> �No ❑ Excessive pond;ng in soil systernlD-boxes <br /> System diSCharge sewage to drain tile �, ❑Yes � Homeowner testimony(See Cnmments/Explana6on) <br /> or surface waters. _ _ � uBlack soiP'above soil dispersal system <br /> Systern cause sewage backup into �! ❑Yes �No ❑ System requires"emergency"pumping <br /> dwelling or establishment. �_____ __ � performed dye test <br /> Any"yes"answer above indicates the system is ❑ Un2ble to verify{See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. ❑ Other methods not listed(See Comments/Explanation) <br /> C o m men tslExpl a nation: <br /> 2. Tank I►ltegt'lty—Compliance component#2 of 5 <br /> Compliance criteria:_ _ Verificatlon method(s): <br /> System consists of a seepage pit, �]Yes � No � Probed tank(s) bottom <br /> cesspool,drywell,or leaching pit. , � Examined construciion records <br /> Saepage pits msetrng 7080.2550meybe ❑ Examined Tank Integrily Form(Attach} <br /> compliant if bllowed in local ordinance. � __ <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s) leak below their I ❑Yes � No [ Examined empty(pumped}tanks(s) <br /> designed o erating depth. __ <br /> If yes,which sewage ta�k(s)leaks: i _ ❑ Probed outside tank(s)for"black soil" <br /> � — - — ❑ Unable to verify(See CommentslExplanation) <br /> Any "yes"answer above indreates the � Other methods not listed(See Comments/Explanation) <br /> system is Failing to Protecf Groundwater. <br /> CommentslExplanation: <br /> Peterson Company pumped the tanks <br /> 3. Othef COmpliarlCe COIldition5-Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked, unsecured,or appear to structurally unsound. ❑Yes` �No ❑Urknown <br /> b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. ❑Yes' �No ❑unknown <br /> *System is an imminent threat to public health and safety <br /> Exp►ain: <br /> c. System is non-prote�ive of ground water for other conditions as determined by inspector ❑Yes' �t�o <br /> 'Syster»is failing ro protect groundwater <br /> Exp�ain: <br /> www.pca.state.mn.us • 651-296-6300 • 8Q0-657-3864 • TTY 651•282-5332 or 800-657-3864 • Avai'�able in altemative formats <br /> wq-wwists4-31 • i/24/72 Paqe2of3 <br />