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Property Address:. j170 Lyman Ave, Orono 55391 <br />Business Name: Chip's Septic Services Date: 10/8/2025 <br />1. Impact on public health — Compliance component #1 of 5 <br />lance criteria: <br />System discharges sewage to the ❑ Yes` ® No <br />ground surface <br />System discharges sewage to drain [I Yes' ®No <br />tile or surface waters. <br />Attached supporting documentation: <br />❑ Other: <br />❑ Not applicable <br />System causes sewage backup into ❑ Yes' ® No <br />dwelling or establishment. <br />Any "yes" answer above indicates the system is an <br />imminent threat to public health and safety. <br />Describe verification methods and results: <br />Visual. Ran pump to determine hydrolic loading of system. Working as designed. <br />2. Tank integrity — Compliance component #2 of 5 <br />Loompuance criteria: <br />System consists of a seepage pit, ❑ Yes' ® No <br />cesspool, drywell, leaching pit, <br />or other pit? <br />Sewage tank(s) leak below their ❑ Yes' ® No <br />designed operating depth? <br />If yes, which sewage tank(s) leaks: <br />Any "yes" answer above indicates the system <br />is failing to protect groundwater. <br />Attached supporting documentation: <br />® Empty tank(s) viewed by inspector <br />Chip's Septic <br />Name of maintenance business: Service Llc <br />License number of maintenance business: 2064 <br />Date of maintenance: 10/8/2025 <br />❑ Existing tank integrity assessment (Attach) <br />Date of maintenance <br />(mm/dd/yyyy): (must be within three vears) <br />(See form instructions to ensure assessment complies with <br />Minn. R. 7082.0700 subp. 4 8 (1)) <br />❑ Tank is Noncompliant (pumping not necessary - explain below) <br />❑ Other: <br />Describe verification methods and results: <br />Tanks were pumped and camera inspected at the time of this inspection. Pump tanks every 3 years <br />https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-wwists4-31b • 412812021 Page 2 of 4 <br />