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Apr 2015 06:16p Joseph Olson 763-498-8290 p.3 <br /> , , <br /> Property address: 755 Hurrt Fartn Road,Orono,MN Inspedor initials/Date: J.O.4117I15 <br /> 1. ImpaCt on PubliC Health—Compliance component#1 of 5 <br /> Com liance cri#eria: Verification rnethod�s): <br /> System discharge sewage to the ❑Yes � No � Searched for surFace outlet <br /> �round surface. � Searched for seeping in yard/backup i�home <br /> System discharge sewage to drain tile ❑Yes �J No � ��Sive ponding in sa'I syslerrW-boxes <br /> or surfBCe waters. ' ❑ Homeowner testimony(See Cpmments�Exalanation) <br /> ❑ `Black soil"above soil dispersal system <br /> S�+stem cause sewage backup irrto � ❑Yes �No <br /> dwelling or estabfishment. i ❑ System requires"emergenc�'purnping <br /> ❑ Performed dye test <br /> Any"yes"answer above indicates the sysiem is ❑ Unable to verify(See Comments�x�anar;o„J <br /> an lmminent Threat to PubJic He�lth and Safety. ❑ Other methods not listed(see Comments/F_xp�anation} <br /> Co mmenislExpla�atan: <br /> 2. Tdllk 111tegfity—Compliance component#2 of 5 <br /> Compliance criteria: Verification method(s): <br /> System coresists of a seepage pit, ; ❑Yes �No � Probed tank{s}bottom <br /> cesspool,drywell,or leaching pit. <br /> � Examined construction records <br /> Seep�ge prts meetrng 7080.2550 may be ❑ Examined Tank Iniegrity Forrn(Altach) <br /> crom liant if allowed in foca/ordinanc�e. <br /> ❑ Observed liquid feve!belowoperatirtg depth <br /> Sewage tank(s)leak below their ❑Yes f�No �] ��mined empty(pumped)tanks(s) <br /> des' n�o ratin de th. � <br /> If yes,which sewage tank(s)leaks; ❑ Probed outside tank(s)for"black soil" <br /> Any"yes"answer above indicafes the ❑ Unabte to uerify(See Comrnents�Explanation) <br /> system is Faiiing to Protect Groundwater. ��her methods not listed (Sse Commer,ts/Explanation) <br /> Comments/Exp la nation: <br /> Peterson Company purr�ed the tanks <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenance hole oovers are damaged,cradced, unsecured,or appear to strtacturally unsour�d. ❑Yes" �No p Unknown <br /> b. Other issues(eledricalhazazls,efc.)t�iminediateiy and adversely impact p�Bc heaNh or safety. ❑Yes" �No ❑ Unknown <br /> '�ystem is arr Immirtent threat#o puWic health a»d safefy <br /> Expla�: <br /> c. System is non-protective of ground water for other conditions as determined by inspedor ❑Yes' �No <br /> aystem is failing M proiect groundwater <br /> ExPlain: <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • T7Y 651-282-5332 or 80D-657-3864 • Availabte in attemative formats <br /> wq-wwists4-31 • 1/24/�2 Page 1 of 3 <br />