Laserfiche WebLink
May 05 2015 02:35PM HP FaxRusty Olson 7634988290 page 5 <br /> Property address: 40 Orono Orchard Road = Inspector initials/Date: 4128115 <br /> 1. Impact on F ublic Health-Compliance component#1 of 5 <br /> Compliance criteria: Verification method(s): <br /> System discharge sewage to the � ❑Yes ❑No 0 Searched for surface outlet <br /> _ground surface. , 0 Searched for seeping in yardlbeckup in home <br /> I System discharge sewage to drain tile i 0 Yes 0 No 0 Ping in soft system/D-boxes <br /> or surface waters. 0 Homeowner testimony(See Commentm/Expranation) <br /> System cause sewage backup into ❑Yes 0 No 0 •Black soil'above sol dispersal system <br /> dwelling or estabwshment ❑ System requires"emergencf pumping <br /> 0 Performed dye test <br /> Any"yes"answer above Indicates the system is ❑ Unable to verify(See CommentsExp/anetan) <br /> an Imminent Threat to Public Health and Safety. 0 Other methods not listed(See Comments/Exptenation) <br /> Comments/Explanation: <br /> 2. Tank Integrity-Compliance component#2 of 5 <br /> Com.!lance cr aria: _ Verification method(s): <br /> System consists • a seepage pit, ❑Yes ®No 0 Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. <br /> ❑ Examined construction records <br /> Sage pits meo ' 7080 2660 may be 0 Examined Tank Integrity Form(Attach) <br /> -• ant hallowed local oidinence. . <br /> Sewage tank(s) 0 Observed liquid level below operating depth <br /> O - below their 0 Yes ®No <br /> __designed ..= -�r , de,I , <br /> El Examined empty(pumped)tanks(s) <br /> If yes,which =.e tank(s)leaks: ❑ Probed outside tank(s)for"black soil' <br /> Any "yes"an=werabove indicates the <br /> ❑ unable to verify(See CommenrstExptagtbn) <br /> system is Fall g to Protect Groundwater. ❑Other methods not listed(See CunanCytxptanation) <br /> __ <br /> Com - . .. -- lila,: <br /> On 4/28/15,Elmer .Peterson Co.moped septic tanks. <br /> 3. Other Complia Conditions-Compbance component#3 of 5 <br /> a. Maintenance covers are damaged,cracked,unsecured,or appear to stnucturaly unsound. 0 Yes' 0 No D linkman <br /> public b. Other issues( ' hazards,etc.)to immediately and adversely impact health or safety. ❑Yeas 0 No 0 Unknown <br /> *System is an i minwt threat to public health and safety <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector 0 Yes' 0 No <br /> *System Is fs/Hng to protect groundwater <br /> Explain: <br /> www.pca.state.mn.us • i51.296.6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available inalternative formats <br /> wo-wwists4-31 • 1124112 <br /> Nee 2of3 <br />