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Apr 1715 09:59a Joseph Olson 763-498-8290 p.3 <br /> Property address: 1a Myrtlewo� Road,_Orono,MN Inspecior initialslDate: J. O.4l13/15 <br /> 1. ImpaCt on Pub�iC Health —Complia�ce component#1 of 5 <br /> Compliance criteria: Ye�ification method(s): <br /> System discharge sewage to the ❑Yes � No � Searched ior surface outlet <br /> ground su�Face. � Searched for seeping in yard/backup in home <br /> System discharge sewage#o drain ti�e ❑Yes �No � ��ssive ponding in soil system/aboxes <br /> or surface waters. ❑ Homeowner testimony{See CommentslExpranation) <br /> ❑ 'Slack soil'above sa!dispersal system <br /> System cause sewage backup irrto ❑Yes 1� No � y�,stem requi�es"emergency"pumping <br /> dwelling or establishment. � <br /> ❑ Performed dye fest <br /> Any'°yes'�answer above indicates the system is ❑ Unable to verify(See CommentsiExplanation) <br /> an tmminent Threat to Pub�ic Hea/th and Safety. ❑ p�her methods not listed(See Conn»ents/F_xpJanation) <br /> C o m m entslE�la natio n: <br /> 2. Tank Inte�rity—Compliance component#2 of 5 <br /> Compliance criteria: Verification method�s): <br /> System consists of a seepage pit, ❑Yes � No � Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. <br /> � Exarrtined oonstreidion records <br /> SeepagE pirs meeting 7080.2550 may be ❑ Examined Tank Integrity Form(Auach} <br /> compliant if allowed in Joeaf orrlinanCe. I <br /> Sewage tank(s)leak below tl�eir � ❑Yes � No � Observed liquid levef belo�w operating depth <br /> , designed operatinq depth. ❑ Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for°black soil" <br /> Any"yes"answer above indicates the ❑ �nable to verify(See Comments/Exp�anation) <br /> system is Failing!o Protecf Groundwater: ❑�1her methods not listed(See Comments/Explenation) <br /> C omme�tslExpEanation: <br /> 3. Other Comp[iante Conditions—Compliance component#3 of 5 <br /> a. Mairnenance hole anrers are damaged,cracked,unsea�red,or appear ta stnidurafty unsound. ❑Yes" �►�o ❑unknown <br /> b. �ther issues(elerxncal hazards,etc.)to irrvnediately and adversely impact public health or safety. ❑Yes" ►8I No ❑Unknown <br /> '�System is an lmminenf lhr+eat to puWic hea/th anaf saf�efy <br /> Explain: <br /> c. System is non-�rotedive of ground water for other condfions as deterrnined by inspector p Yes= �No <br /> 'System is faifing to pratect grounahvater <br /> E�lain: <br /> www.pca.scate.mn.us • 651-296-6300 . B00-657-3864 • 77'Y 651-282-5332 or 800-657-3864 • Available in altemative formats <br /> wq-vrwists43 f • iI29!12 Page 2 of 3 <br />