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• Property address: 2400 Woodhaven Drive.,Orono,MN Inspector initials/Date: J.O.7/30/12 <br /> 1. Impact on Public Health—Compliance component#1 of 5 <br /> Compliance criteria: Verification method(s): <br /> System discharge sewage to the 0 Yes ®No ® Searched for surface outlet <br /> ground surface. ® Searched for seeping in yard/backup in home <br /> System discharge sewage to drain the ❑Yes ®No ❑ Excessive ponding in soil system/D boxes <br /> or surface waters. 0 Homeowner testimony(See Comments/Explanatan) <br /> System cause sewage backup into Yes ®No 0 Black sort above soil dispersal system <br /> dwelling or establishment ❑ System requires emergency pumping <br /> 0 Performed dye test <br /> Any"yes"answer above indicates the system is 0 Unable to verify(See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. ❑ Other methods not listed(See Comments/Explanaton) <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 0 Probed tank(s)bottom <br /> cesspool,drywall,or leaching pit. 0 Examined construction records <br /> Seepage Pits meeting 70802550 may be ❑ Examined Tank Integrity Form(Attach) <br /> compliant I allowed in local ordnance. <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s)leak below their ❑Yes ®No 0 Examined <br /> designed operating depth. empty(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for`black soil" <br /> Any"yes"answer above inthcates the ❑ Unable to verify(See CommerhtdErplanation) <br /> system is Failing to Protect Groundwater. 12:1 Other not fisted(See Comments/Explanation) <br /> Comments/Explanation: <br /> Elmer J Peterson pumped the tanks on 7/27/12 <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes` No 0 Unknown <br /> b. Other issues(electrical hazards,ems)to immediately and adversely impact public health or safety. 0 Yes* ®No 0 Unknown <br /> 'System is an imminent threat to public health and safety <br /> Explain: <br /> c. System is nonprotective of ground water for other conditions as determined by inspector 0 Yes- ®No <br /> *System is failing to protect groundwater <br /> Explain: <br /> www.ptastate.mn.ua • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 - Available in alternative formats <br /> wq-wwtsts4-31 - 1/24/12 <br /> Pose 2of3 <br />