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Ju111 1212:04p Joseph Olson 763-498-5290 p,3 <br /> , , <br /> � Property address: 1749 I�orth Farrn Road.,Oror�o,MI� Inspedor inifizals/0ate: J.O.7/11/12 <br /> 4. lmpatt on Pubiic Health-Compiiance component#1 of 5 <br /> Com liance criteria: Yerifrcation method(s): <br /> System disd�arge sewage to the ❑Yes �No � �arched for surface outlet <br /> round surface. � Sesrched for seepi�in yard/backup in h�me <br /> System d�sdiarge sewage to drain ti� ❑Y� � No � ����g�nding in soil systemlD-bo�oes <br /> or surFace waters. ' ❑ Homeowner tesdmony(See Comments/Exp�enation) <br /> ❑ "Black soil`above sal dispersal sysiem <br /> System cause sewage backup irrto � ❑Yes � No ❑ System uires'em <br /> dwelling or establishrnerri. �1 er9ency'pumping <br /> ❑ Pe�Formed dye test <br /> Any"yes"answer ahove indfcates the system is ❑ Unable to verify�see car►mer�cpra►,erion) <br /> an lmminent Thre�at to Public Heal�and Saf�y. � p�er methods not listed (See Gomrr,enfs/Fxplanation) <br /> Comments/F�q�lanation: <br /> 2. Tank Integrity—Complianoe componerit#Z of 5 <br /> Com liance criteria: Ver�cation method(s): <br /> System consists of a seepage pit, ❑Yes �No ❑ Probed tank(s) bottom <br /> cesspool,drywell,or leaching pit ❑ Enamined construction records <br /> Seepaga pits meetfng 7080.2550 may be ❑ Examined Tank Integrity Form (Aftach) <br /> ient��allowed in foCal adinar+oe. <br /> ❑ Obse►ved liquid�vel below operating depth <br /> Sewage tank(s)leak below their ❑Yes � No � ��mined em <br /> desi ned ratin de pty(pumpe�tanks(s) <br /> If yes,arhich sewage tank(s)�eaks: ❑ Probed outside tank(s)for°black sa7" <br /> Any"yes"answer above indlcates the ❑ Ut�eble to verlfy(See Commenfs/Expfanation) <br /> system is Failing�o Protect Groundwater. �Other methods not listed(See Comments/Explenation) <br /> commentslExplanabon: <br /> Elrner,f Peterson pumped t#�a tanks on 7/09/t2 <br /> 3. d�her Compliance Conditions—Compliance component#3 of v <br /> a. Maintenance hole covers are damaged,crackec#,unsecured,a appear tio structuraAy unsound. ❑Yes• �No ❑iJr�tcnown <br /> b. Other issues(elecbicar lrazards,eac.)to immediately and adversely impact public F�alth or safely. p Yes' �No O Unknown <br /> '"Syst+em is an imminerrt�hieat!a public health and safety <br /> F�lain: <br /> c. System is n�n-pratective af ground watec for oiher conditions as de�termined by inspedor p Yes• �No <br /> "Sysiem is failing to prvUect grourtdwate�r <br /> Ea�lain: <br /> www.pwstate.mn.us • 661-296•6300 • 800-657-3864 • TTY 651-282-5332 or 600-657-3864 • Available 1n a{temative formats <br />