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onsite sewage treatment system/compliance inspection form
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3745 Watertown Road - 32-118-23-34-0012
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onsite sewage treatment system/compliance inspection form
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Last modified
8/22/2023 4:41:00 PM
Creation date
10/23/2019 10:36:35 AM
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x Address Old
House Number
3745
Street Name
Watertown
Street Type
Road
Address
3745 Watertown Road
Document Type
Septic
PIN
3211823340012
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Dec 1812 04:04p Joseph Olson 763-498-8290 p,3 <br /> Property address: 3743 Watertown Road Orono,MN _ Inspectorinitials/Date: 10. 12/14/12 <br /> I. Impact on Public Health—Compliance component#1 of.5 <br /> Compliance criteria: Verification method(s): <br /> System discharge sewage to the Q Yes ®No 0 Searched for surface outlet <br /> ground surface- _ ® Searched for seeping in yarrllbadcup in home <br /> System discharge sewage to drain the ❑ Yes ®No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. — ❑ Homeowner testimony(see Comments/Expl"ian) <br /> System cause sewage backup into ❑Yes ER No ❑ "Black soil"above soil dispersal system <br /> dwelling or establishment. ❑ System requires"emergency'pumping <br /> Any"yes"answer above indicates the system is ❑ Performed dye test <br /> an Imminent Threat to Public Health and Safety, ❑ Unable to verify(see Comments/Explanation) <br /> El methods not listed(See Comrnents/Explanatfon) <br /> Comments/Explanation: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Compliance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑Yes ® No ❑ Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. <br /> ❑ Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank integrity Form(Attach) <br /> com iiant if Mowed in lord ordinerrce. <br /> ❑ Observed liquid leve{below operating depth <br /> Sewage tank(s)leak below their El Yes ®No <br /> designed operating depth. _ ® Examined empty(pumped)tanks(s) <br /> If'yes,which sewage tank(s) leaks: ❑ Probed outside tank(s)for"black soil' <br /> Ry "yes"answer above indicates the El Unable to verify(See CommentslExplenation) <br /> system is Failing to Protect Groundwater. ® Other methods not listed(See CommenM,JExplanadon) <br /> C: mments/Fxplanation: <br /> Elmer J Peterson pumped the tanks on 4/27112 <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. .Maintenance We covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes* ®No ❑unknown <br /> b. Other issues("deka/hazanis,etc.)to immediately and adversely impact public health or safety. ❑Yes* ®No ❑Unknown <br /> *System is an imminent thfeat to public health and safety <br /> Explain: <br /> C. System is non-protective of ground water for other conditions as determined by inspector ❑Yes* ®No <br /> *System is failing to protiect groundwater <br /> L, <br /> Explain: <br /> www.pca.state.mn.us 654-296-6300 800.657-3864 TTY 651-282-5332 or 800-657-3864 Available in alternative formats <br />
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