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. 4 <br /> � <br /> PropeR�►addresa: 27�30 Rairroy Rd.Orono,MN ---._.. tnspector initielslDabe:. � 10/47/1018 <br /> f+�YY!'Y! <br /> 1. 1 rpact on Rublfc Health—Cornp�ianoe oorrrponent#1 of 3 <br /> ComMiar+o�ari�s�ia: . . verMlcaelon meltwd(s): <br /> 9�em d�r�a a�ge�o,l�e a Yes �No a s�d�ea 4or s�ufaoe«,riec <br /> g���• _-.. _..— �SearGhed for aeepinp in yardlbadu�p in horrre <br /> $yslem di�a�sewa�e�o drs�n ❑Y�s �No ❑E�ossshre ponding in soru systemlD-bo�oes <br /> tIe or saktoe a►eters. _. ❑Homeo�wner testimotty lsse Glornrtaenta/F�cpfarretion) <br /> $ystem causes sewege bedap irsto ' ❑Yss �Nc ❑"Bfack soN'abo�re so�dtspersal sYs�sm <br /> dw�eNing a eatab�shmer�t. . ❑�+re�s b��"9�Y P���9 <br /> Any"�ea"�swe�r�bove fndi�ai�as�e ❑�dye eeec <br /> sysMn!IS elt Nnminerrt�er�t to pub!!c p l�e to ve�rY lsee 1 <br /> hv�Mh and aa�ety. _.. �otl�er meu�ods not Nstea rse. <br /> Comme�lExNlan�tlon: <br /> 2. Tank Integlrity--Comp�arwe companent#2 of 5 <br /> Compli�nos chbNa: . V�riflcatia�nwtlwd(s�: <br /> System oonsiats of s seepape Pit. ❑Yes �No ❑Probed tsr�lc(s}bot60m <br /> oesspool,dryw�eY.or IeadMnp pit. ❑�xatnirred oonslct�ia�n reoor+ds <br /> 3�pe�e P�a�7oe0 236o rr,�y be ❑Exami�ed Tank Inte�y Form(Af%h) <br /> M aNrnred b�lood ordfner�oa. <br /> seyrag�t�dc(e)leak beloM►u� �Yes p No ❑ob�rved Nqutd le�el beloM►�ne deplf► <br /> ��oP�B d�• �Exarr�irbd empty(PumPe��Sts) <br /> If Yos.whioh se+�ge tank(s)teaks: �Prnb�d oe�lside tank(sj�'�ladc sdi' <br /> My`�"a�swer abov�e�riaicai+es the ❑unaae�verirr(see vo�n�c�) <br /> 8y�m�i f��6fg!hD p�0t�9Ct�I+OfMdN►at� ❑Other melhods rwt Ns1ed{See ' ) <br /> CommanblF#planatlon: <br /> majar rod intr�uaion�ro�gl►t�lc Nds.ri�s ar�d Mlets of tardcs. <br /> 3. Other Cormpliance Cortditions—compii�noe oomponei,t#3 ot 5 <br /> , <br /> s. AAeintenanoe hole oanrens e�e dan�aged,cxac�ced,uneeaur+ed,ar appear io be str»chualy ursound. ❑Yes• �No p lM1u+oMm <br /> b. Otlier'isaues(aledr�caf�e�b�rrr�edrelelY and ad�reraeh►irtipact PubMc healEh a�. ❑Yes" �No ❑lhimown <br /> 'S�ae�rrr�ls�n 6�Mn�ntUM�atf�pvblNe MM�a�dsslb[�►. <br /> ��. <br /> c- S]►a�en�is ran-P�e of 9round vrapi�for clhs�oo�ons�d�wmined bY i�pocEor• ❑rer ��+o <br /> 'Syaean 1s IJ�A�riq b�ProOsct grou�er. <br /> E�cptaln; <br /> www.Pca.staoe.mn.us • �,�-z914-6300 : eoo-bsr-3�6�s • m 6s�-ZSZ-s33z or soo-6sT-3�bt • �railab�e 1n atGemache ronnats <br /> wq-wwists�-31b � 6/4!i�t Page 2 oJ 3 <br />