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Property address: 625 Spring Hill Rd,Orono Inspector initiais/Date:�- � 2/22/2017 <br /> (mn✓dd/YYri) <br /> 1. Impact on Pubtic Health—Compiiance component#1 of 5 <br /> Com Ilance crlterla: Verification method(s): <br /> System discharges sewage to the ❑Yes � No �Searched for surface outlet <br /> round surface. �Searched for seeping in yard/backup in home <br /> System discharges sewage to drain ❑Yes �No ❑Excessive ponding in soil system/D-boxes <br /> tile or surface maters. <br /> ❑Homeowner testimony(See CommentsiExplenation) <br /> System causes sewage badcup into ❑Yes �No ❑"Bladc soil°above soil dispersal system <br /> dwelling or establishment <br /> ❑System requires"emerge�cy"pumping <br /> Any"yes"answer above in�cates the p Per�ormed dye test <br /> system is an imminent threat to public ❑Unable to veri(y(See CommentslExp/anation) <br /> hea/th and safety. ❑Other methods not listed(see Comments�xp►anation) <br /> Comments/Explanation: <br /> 2. Tank Integrity—Compliance component#2 of 5 ' <br /> Com liance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑Yes �No �Probed tank(s)bottom <br /> cesspool,dryweil,or leaching pit. <br /> ❑Examined construcction records <br /> Seepage pits meeSng 7080.2550 may be ❑Examined Tank Integrity Form(Attach) <br /> liant if allowed in loca!ordinance. <br /> Sewage tank(s)leak t�low their ❑Yes �No �Obsen►ed liquid levef below operatirtg depth <br /> designed operating depth. ❑ Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: �Probed outside tank(s)for"black soi!" <br /> Any"yes"answer above indicates the ❑Unable to verify(See Comments/Explanation) ' <br /> system is failing to protect groundwater. ❑Other methods not listed(See CommentslExplanadon) <br /> Com ments/Explanation: <br /> .Tanks were not pumped at time of inspection. Existing tanks are pre-cast <br /> 3. Other COmplidllCe Col7ditions—Compliance component#3 of 5 ' <br /> a. Maintenance hole oovers are damaged,cracked,unsecured,or appear to be structurally unsound. O Yes" �No ❑Unknown <br /> b. Other issues(elec�nrca�hazarrls,etc.)to immediately and adversely impad public heal�or safety. ❑Yes" �No ❑Unkn�vn <br /> '�ystem is an Imminent threat to public health and safety. <br /> Explain: <br /> c. System is non-protective of ground water for other oonditions as determined by inspedor. ❑Yes• �No <br /> *System is failfng to protectgrounafwater. ' <br /> Euplain: <br /> www.pca.state.mn.us • b51-296-6300 • 500-657-3864 • TTY 651-282-5332 or 800-657-3864 w Availabte in attemative formats <br /> wq-wwists4-31 • 3/16/12 Pnge 2 of 3 <br />