Laserfiche WebLink
I- <br /> Property address: 2060 Weber Hills Road,Orono,Mn 55391 Inspector initials/Date: djd 17/2/2013 <br /> (mm/dd/yyyy) <br /> 1 . Impact on Public Health— Compliance component#1 of 5 <br /> Compliance criteria: Verification method(s): <br /> System discharges sewage to the 0 Yes ® No ❑ Searched for surface outlet <br /> ground surface. ® Searched for seeping in yard/backup in home <br /> System discharges sewage to drain ❑Yes ® No 0 Excessive ponding in soil system/D-boxes <br /> the or surface waters. <br /> -- CI Homeowner testimony(See Comments/Explanation) <br /> System causes sewage backup into ❑Yes ❑ No 0 "Black soil"above soil dispersal system <br /> dwelling or establishment. <br /> 0 System requires"emergency"pumping <br /> Any"yes"answer above indicates the ❑ Performed dye test <br /> system is an imminent threat to public ® Unable to verify(See Comments/Explanation) <br /> health and safety. <br /> ❑ Other methods not listed (See Comments/Explanation) <br /> Comments/Explanation: <br /> Home not inhabited. Unable to verify previous sewage backup into home. <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Compliance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑Yes ® No El Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. <br /> 0 Examined construction records <br /> Seepage pits meeting 7080.2550 may be 0 Examined Tank Integrity Form(Attach) <br /> compliant if allowed in local ordinance. <br /> CI Sewage tank(s)leak below their ❑Yes DI No <br /> Observed liquid level below operating depth <br /> designed operating depth. 0 Examined empty(pumped)tanks(s) <br /> If yes,which sewage tank(s) leaks: ❑ Probed outside tank(s)for"black soil" <br /> Any"yes"answer above indicates the ® unable to verify(See Comments/Explanation) <br /> system is failing to protect groundwater. 0 Other methods not listed (See Comments/Explanation) <br /> Comments/Explanation: <br /> Tanks are solid, preformed concrete with baffles and solid bottom. Unable to verify any tank leakage issues. <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked, unsecured,or appear to be structurally unsound. ❑Yes" ®No ❑ Unknown <br /> b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. ❑Yes"" ®No ❑ Unknown <br /> *System is an imminent threat 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 protect groundwater. <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • 3/16/12 Page 2 of 3 <br />