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� � � <br /> � 3of9 � <br /> Property address: 315 Hollander Rd,Orono, MN 55391 Inspector initials/Date: 7/27/2017�i� <br /> 1. ImpaCt on PubliC Health —Compliance component#1 of 5 <br /> Com liance criteria: Verification method(s): <br /> System discharge sewage to the ❑Yes � No � Searched for surface outlet <br /> round surface. � Searched for seeping in yard/backup in home <br /> System discharge sewage to drain tile ❑Yes � No � Excessive ponding in soil system/D-boxes <br /> or surface waters. ❑ Homeowner testimony(See Comments/Explanation) <br /> System cause sewage backup into ❑ Yes � No � ��Black soil"above soil dispersal system <br /> dwelling or establishment. ❑ System requires"emergency"pumping <br /> ❑ Performed dye test <br /> Any"yes"answer above indicates the system is ❑ Unable to verify(See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. ❑ Other methods not listed (See Comments/Explanation) <br /> CommentslExplanation: <br /> None of the above found. <br /> 2. Tdllk 111teg1'ity—Compliance component#2 of 5 <br /> Com liance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑Yes � No � Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. ❑ Examined construction records - <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Form (Attach) <br /> com liant if allowed in local ordinance. <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s)leak below their ❑ Yes � No <br /> desi ned o eratin de th. ❑ Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil" <br /> ❑ Unable to verify(See Comments/Explanation) <br /> Any "yes"answer above indicates the <br /> Syst@m iS Falling to PPOteCt GCoulldwatel'. � Other methods not listed(See Comments/Explanation) <br /> Comments/Explanation: <br /> Lowered underwater camera into tanks-baffles and tank walls OK. <br /> It should be noted that the effluent filter was plugged and was causing a high liquid level in the septic tanks. The filter should <br /> be cleaned and the filter alarm should be checked to see if it is working properly. <br /> 3. Oth2r COI'T1plldllCe COIld1t10115—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes* �No ❑Unknown <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 /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector ❑Yes` �No <br /> `System is failing to protect groundwater <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • 1/24/12 Page 2 of 3 <br />