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<br /> Property address:�4225 Coun Road B Orono MN.55 6 Inspector ini6alslDste: 12/9/2012
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<br /> 1. Impatt on Pub�ic Health—,Compliance component#1 of 5
<br /> Com liance criteria: ' ' Verification method(s):
<br /> System discharges�ewage to the ' �Yes � No �Searched for surtace outlet
<br /> � round surface. � �Searched for seeping in yard/backup in home
<br /> �;System discharges�ew�,g�,to drain ❑Yes � No ,, ❑Excessive ponding in soilsystem/D-boxes
<br /> tile or surFace waters.
<br /> p Homeowner�testimony(See Comments/Explanatron)
<br /> �9yistem causes sew�ge backup irito ❑Yes �No ❑"Black soil"above soil dispe�sal system
<br /> dwelling or establishment.
<br /> ❑System requires"emergenc�'pumping
<br /> _Any"yes"answer above indicates the ❑ Pertormed dye test
<br /> system is an�mm�nent threat�to public ❑ Unable to verify(See Comments/Explanetion)
<br /> .health and safety. "
<br /> �� � � ❑Other methods nat listed(See Comments/Exp/anation)
<br /> Commerrts/Explan tion: . �
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<br /> ' �r,��lrm�--e �/�io�z.
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<br /> Tank Integrity-Compliance component#2�of 5�^
<br /> � m liance criteria:�_; > - . � � Verificatio� method(s):
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<br /> System consists of a seepage pd, "� ❑Yes � No � Probed tank(s)bottom.�
<br /> eesspool,d . ell,or leaching pit., .. __ , � Examined construcction�records
<br /> Seepege pits ting 7�08o�25s0�may be � Examined Tank Integrlty FoRn(Attech)
<br /> m liant if al owed in loca!ordinance.
<br /> S��age,�nl�s) leakb�slowtheir. ❑Yes �No q � P��bng deptYi
<br /> [� Observed li uid Igval b�low v
<br /> d g perating depth. ❑ EXamined empty(pumped)ta'nks(s) �
<br /> If es�which�ewage.,tank(s)le�ks; ❑ Probed outside t2nk(s)for"b�ack soil'
<br /> • ❑ Unabfe to veri (See��ommsnfslExp�anation)
<br /> _An'y'�",y�s'=`answe�above mdicates the _ �
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<br /> ,�� e .is=#aili g to�- ,rotect;(�!�[IlfdWatel. 0 �er methods not listed(See Comments/�Eicp/anallon)
<br /> Gomments/Explahatio�►t � -,: . . d �/'e��'�[�� L��l, ...�?"r����.N .
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<br /> �cirisulted� U for Records � /
<br /> � _____ �d Nj��/��-. 'g' 1i 2�O1�' . .r .
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<br /> 3. Other Co�ptiance Conditions—Compliance component#3 of 5
<br /> a. Mainten�nce hole cove�s are damaged,cracked,unsecured,or appear to be structurally unsound. ❑Yes` �No ❑Unknown
<br /> ��• �.�'Othi�r issues electr�l•li�iard etc. to immetli�l snd adve im act I'
<br /> ___._ ..(.... ,__.__.w.. �._...�._ Y.' �X. A Pyb�c health Of&��Ety...._._D Yes"..�.�IQ D unknown
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<br /> Syysi�eem is$n=rmminent thl+eat to pablic hea/th aRd safety. , � ���r}�;
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<br /> Explain:
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<br /> -cr'" System is'ndn�r�at�'ctnis�of ground water for other oonditions as determined by inspector.,� ukp.YesF f�No
<br /> , ,�m is faiUn9.�o prtoaect groundwatar. ;,.; .
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<br /> Explam` `"` ` � e�,►'Yl C� �a.. �tor•�.�
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<br /> www.p�a.state.mn.u� • , 651-296-6300 . 800•657-3864 • TTY 651•282-5332 or 800-657-3864 • � Available in altemdtive formats
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