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Jul 12 13 06:38a Joseph Olson 763-498-8290 p.3 <br /> c Property address: 3680 Jacobs Mill Road,Orono, MN � Inspector initialslDaie: J.O. 7/03/13 <br /> 1. 1171p8Ct On PubliC Hedlth—C�mpliance companent#1 of 5 <br /> Com liance criteria: Verification method(s}: <br /> System discharge sewage to t#�e ❑Yes �No � Searched for surface outlet <br /> round su►face. � Searched for seeping in yardl6ackup in home <br /> System discharge sewage to drain tile ❑Yes Q� No � �xcessive ponding in soil systemlD-boxes <br /> or surFace waters. ❑ Homeowner testimony(See CommentslExpianaGon) <br /> ❑ "81adt soil"above soil dispersal system <br /> System cause sewage backup into ❑Yes � No � System requires"err�ergency"pumping <br /> dwellirtg or establishm�t. <br /> ❑ PerFormed dye test <br /> Any"yes"answer above indlcates!he system is ❑ Unable to verity(See CarrrmentslFxplanation) <br /> an lmminent 7'hreat to Public Heafth and Safety. ❑ Other methods not listed(See Comments✓Fxp/anation) <br /> Com mentslExplanation: <br /> 2. Tank Integr'ity—Compiiance component#2 of 5 <br /> Com�liance criteria: Verification meti�od�s): <br /> System cansists of a seepage pit, ❑Yes � NQ � Probed tank(s)bottorn <br /> cesspool,drywell,or leaching pi� � Examined construction records <br /> 5eepaqe pits meeting 7080.2350 may be ❑ Examined Tar�k Integrity Form(Attadr) <br /> com fiarrf if allowed in loca!ordmance_ <br /> Sewage tank(s)leak beEow their �Yes �No � ���ed liquid le�el bebw operating cle�th <br /> designed operating depth. ❑ Exarnined empty(pumped)tanks{s) <br /> If yes,which sewage tank(s)beaks: • ❑ Probed outs�de tank{s)fw`bJack soiP' <br /> Any"yes"answer above in�cates the ❑ Unable to�erify�See Comments/Exp�anat;or,) <br /> system is Farling to Profect Groundwarer. ����m�hods not listed(See Commeats�ExpJanation) <br /> CommeMs/Exptanation: <br /> 3. Uther Compliar�ce Conditions—CompGance component#3 of 5 <br /> a. Mainienance hole covers are damaged,cradced, unsecured,or appear to stn�cluraliy ur�sound. p Yes" �No p Unknown <br /> b. Other issues(electricaf haza►ds,et�.)to irrunediabely and adversely impact public health or safety, O Yes' �No p Urdccnown <br /> `5ystem is an immi►iertt threat to public health and safety <br /> Explain: <br /> c. Sys�m is n�t-protedive of ground water for other conditions as detemtined by inspedor �Yes' �n�o <br /> 'System is failing to p►+vdectgroundwat�er <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 80(1-657-3864 • 7TY 651-282-5332 or 800-b57-3864 • Available in alcernative formats <br /> wq-wwists4-3f • f/24/f2 Page 2 of 3 <br />