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Jun 1413 11:33a Joseph Olson 763-498-8290 p.3 <br /> ?foperty address� 1480 Green Trees Road.,Orona, MN inspedor initialslDate: _ J.O. 6114l13 ______ <br /> � <br /> 1. Impa�t on Public Health—Compliance component#1 of 5 <br /> _Compliance criteria: _ Verification method(s): <br /> System discharge sewage to the ❑Yes � No � Searched for surface ouffet <br /> _c,Lround surface. __ _ _ _ _ _ _ _ _ � Searched for seeping ir�yardJbacfcup in home <br /> Sysfem discharge sewage to drain tile ❑Yes 1� No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. ❑ Homeov�er testimony(See Comments�E�cplana6on) <br /> __-- ------__� . _ _ __ — — <br /> -- - - "Black soil"above soil dispersal system <br /> System cause sewage backup into ❑Yes � No <br /> dwelling or eslablishment. ❑ System requires"emergency"pumping <br /> — - ❑ Performed dye test <br /> Any"yes"answer ab�ve indicates fhe system is ❑ Unable to verify(See CommentsiExp�anation) <br /> an Imminent Threat fo Public Health and Safety. ❑ Other methods not listed(See Comments/Erplanatron) <br /> Comments/Explanation: <br /> 2. Tdflic ITltegr'lty-Comptiance component#2 of 5 <br /> Cvmptiance criteria: _ Verification method(s): <br /> System consists of a seepage pit ❑ Yes � No ❑ Probed tank(s)bottom <br /> cesspool, dryvrell, or leaching pit_ ❑ Examined eonstruction records <br /> Seepage pits meetirg 7080.2550 may be ❑ Exami�ed 7ank Integrity Form(Attach) <br /> can liant if allowed rn Iocal ordrnance. <br /> ❑ Observed liquid level below operating depth <br /> Sewage iank(s)leak below iheir ❑ Yes ❑ No <br /> desi9ned operating deplh. ❑ Examined empty(pumped) lanks{s) <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil" <br /> AI�y "yes"answer above indicafes the � Unable to verify(See Comments/Exp►anation) <br /> system is Failing to Protect Groundwater. � Other methods not listed(See Commenrs/Explanation) <br /> CommentslExplanatio�: <br /> Did not veriiy.The drainfield is noncompliant.The owners may hook up io city sewer. <br /> 3. Other ComplidnCe COndltiOnS—Comp€iance component#3 of 5 <br /> a. Maintenance ho[e oovers are damaged,tx�cked,unseairsd,or appear io struclurally unsound. �Yes' �No p Unknown <br /> b. Other issues(electncalhazanis,et�.)to immediaiely and aduerse�y impact public health or safety_ [�Yes* �No ❑Unknovun <br /> *Sysfem is an rmminent threaf to pablic healfh and safety <br /> Explain: <br /> c. Systern is non-protective of ground watier for other conditions as determined by inspector p Yes� �No <br /> 'System is farling fo protect groundwater <br /> Explain: <br /> www.pca.state.mn_vs • 651-296-4300 • 800-657-3864 • 1TY 651-282-5332 or 800-657-3864 • Available in a[temative formats <br /> wq-wwists4-31 - i/24!12 Ptrge 2 of 3 <br />