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Apr 29 1411:13a Joseph Olson 763-498-8290 p.3 <br /> Property address: 30 Orono Orchard Road,Orono, MN Inspector initiais/Date: J. 0.225/14 <br /> 1. ImpaCt O� PubliC Hedlth—Compliance component#1 of 5 <br /> Com liance criteria: Verificatan method(s): <br /> Sysbern discharge sewage io the ❑Yes �No � Searched iar surface outlet <br /> round surFace. � Searohed for seeping�yardlbadcup in home <br /> System discharge sewage to drain tile ❑Yes Q�No <br /> ❑ Excessive ponding in soii system/D-boxes <br /> or surface waters. ❑ Homeowner testimary(See Comments�xp�anatnon) <br /> System canse sevwage bacicup i�o ❑Yes �No � �8lack soil"above soil dispersal system <br /> dwetling or establishment. , ❑ System requires`emergency' pumping <br /> ❑ Performed dye test <br /> Any"yes"answerabove indicates the system fs ❑ Unable to verify(see Comments✓Exp�arration) <br /> aR Imminent Threat tn Public Health and Safefy. ❑ Other methods not listed{5ee CommantslExplanation) <br /> Comrn ents/Expianatiai: <br /> 2. Tclnk Inte�rity—Compliartce comp�nent#2 of 5 <br /> Com liance criteria: Veri�cation method(s�: <br /> System consists of a seepage pit, []Yes �No � Probed tank(s}bottom <br /> cesspoal,dryaveEl,or leac�ing pi1. � E�ramfned constnx�ion records <br /> Seenagoe pi�s me8ting 7080.2550 maybe ❑ Examined Tank Integrity Form(Attach) <br /> amRXent if allowed in local o�nance. , <br /> � Q Observed liquid level below aperating depth <br /> Sewage tank(s)ieak below their � ❑Yes �No Q �mined empty(pumped)tanks(s) <br /> desi ned o atin de th. <br /> !f yes,which sewage fank(s)leaks: ❑ Prob�outside t�k(s}far'bladc soil° <br /> Any`�es"ar�swer above indicafes the ❑ unab�e to verity�see comr�nts��a►rarion� <br /> system is Failing to Protect Gr+�undwater. �I �lher methods not listed(See Camments/E,rplanation) <br /> Commenls/Expianatiort: <br /> Peterson Company pumped the tanks. <br /> 3. Other Compliance Conditions—Comp�iance component#3 ot 5 <br /> a. I�Rainbeflance hole oo�ers are darnaged,cradced,unsecured,or appear to siructuraUy unsound. ❑Yes` �No p Unkr�m <br /> b. Ofher issues(elecbrcal hazard�etc_)to immediate�y and adversely impad public heaqh or safety. ❑tres" �J No ❑Unknown <br /> *SysMm is an irnminent Lh�+eat to pubrc health and safdy <br /> Explain: <br /> c. System is r�on-protective of ground water for other conditions as determined by inspector ❑Yes� �No <br /> 'Sysdei»is failing!o protect groundwater <br /> Facplain_ <br /> www.pca.state.mn.u5 • 651-296-6300 • 800-657-38b9 . FTY 65f-282-5332 or 80o-657-381�4 • Availabie in altemative formats <br /> wq-wwfsts4-34 • 1124/11 <br /> Page 2 of 3 <br />