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Mar 11 13 01:25p Jo�ph Olson 763-498-8290 p.3 <br /> ' Property address: 160 Golden Vew Dr..Orono, MN Inspector initialslDate: J. O.03/11113 <br /> 1 . Impact o Public Health—Compliance component#1 of 5 <br /> Corn lianc criteria: Verification method(s): <br /> System disc rge s�ewage to the ❑Yes � No � Searched for surface outlet <br /> round surfa e. � Searched for seeping in yardlbackup in home <br /> S�stem discf rge wage to drai�tile ❑Yes � No ❑ Excessive ponding in soil system/D-boxes <br /> or Surface w ers_� ❑ Homeowne[iestimony(See Commenfs�xplar�silon) <br /> ❑ `Black soil"above soil dispersal system <br /> Systern caus sew ge backup into ❑Yes � No ❑ System requires"emergency"pumping <br /> dwelling or e tablis menf. <br /> ❑ Performed dye test <br /> Any"yes" ns r above indicates the system is ❑ Unable to verify (See Comments�xplanacion) <br /> an lmmiR t Threat to Public Hea1tN and Safety. ❑ Other methods nat listed (See CommentslEttplanafion) <br /> CommerrtslE planation: <br /> 2. Tenk 1nte�rity—Compliance component#2 of 5 <br /> Com lianc criteria: Verification method(s): <br /> System cons s of a seepage pit, ❑Yes � No ❑ Probed tank(s)bottom <br /> cesspool,dry�well,4r leaching pit. ❑ Examined conslruction records <br /> Seepage pits I eetirrg 7080.2550 may be ; ❑ Fxamined Tank Iniegrity Form(Attach) <br /> �om liant if al1 yred in local ordinance. I <br /> � ❑ Observed liquid levef below ope�ating depth <br /> Sewage tank s) leak below their ' ❑Yes � No � ��ined empty(pumped)tanks(s) <br /> desi ned o ratin de th. <br /> If yes,which�ewage tank(s) leaks: ❑ Qrobed outside tank(s)for`black soil" <br /> Any "yes' answerabove indicaies fhe � �nable to verify(See Commen2s�Explaaation) <br /> 5j/S'f@/►1 fS�l�ailing fo Profect Groundwater. �O�her methods not listed (See CommeRts/Explanation) <br /> � <br /> Comments! planation: <br /> EEmer J Pet son pumped the tanks on 6113112 <br /> 3. Othe� COiP'lpliance COndit1o�15—Compliance component#3 of 5 <br /> a. Maintenar�ce hole covers are damaged,cracked,unsecured,or appear to strudurally unsound. ❑Yes" �No ❑unknown <br /> b. Other�ss4es(electricalhazards,e1c.)to immediately and adversety impact public healEh or safety. ❑Yes' �No ❑Unknown <br /> "System an immMent thr�eaf to pu6lic health andsafefy <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector ❑Yes' �No <br /> `System failing to protectgroundwater <br /> Explain: <br /> � <br /> www.nra_ctatp.mn_i c . h51-296-h300 . 500-657-3864 . TTY 651-2ffi-5332or B0�-b57-3864 - AvdiLdbleln elternative forntats <br />