06-15-2020 Septic Compliance Cert.

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Property address: 315 Old Crystal Bay Road Northt Inspector initials/Date: RLP 06/15/2020 (mm/dd/yyyy) 1. Impact on Public Health — Compliance component #1 of 5 Compliance criteria: Verification method(s): System discharges sewage to the ❑ Yes ® No ❑ Searched for surface outlet round surface. ❑ Searched for seeping in yard/backup in home System discharges sewage to drain ❑ Yes ® No ❑ Excessive ponding in soil system/D-boxes the or surface waters. ❑ Homeowner testimony (See Comments/Explanation) System causes sewage backup into ❑ Yes ® No ❑ "Black soil" above soil dispersal system dwelling or establishment. ❑ System requires "emergency" pumping Any "yes" answer above indicates the ❑ Performed dye test system is an imminent threat to public ❑ Unable to verify (See Comments/Explanation) health and safety, ❑ Other methods not listed (See Comments/Explanation) Comments/Explanation: New Installation 2. Tank Integrity — Compliance component #2 of 5 Compliance criteria: Verification method(s): System consists of a seepage pit, ❑ Yes ® No cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. Sewage tank(s) leak below their ❑ Yes fVl No designed operating depth. If yes, which sewage tank(s) leaks: Any "yes" answer above indicates the system is failing to protect groundwater. Comments/Explanation: Inspected installation of new tanks ❑ Probed tank(s) bottom ❑ Examined construction records ❑ Examined Tank Integrity Form (Attach) ❑ Observed liquid level below operating depth ❑ Examined empty (pumped) tanks(s) ❑ Probed outside tank(s) for "black soil" ❑ Unable to verify (See Comments/Explanation) ❑ Other methods not listed (See Comments/Explanation) 3. Other Compliance Conditions — Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. ❑ Yes* ® No ❑ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. ❑ Yes* ® No ❑ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non -protective of ground water for other conditions as determined by inspector. ❑ Yes* ® No *System is failing to protect groundwater. Explain: Page 2of3