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Property Address: 591 North Stream Road, Orono 55391 <br />Business Name: Chip's Septic Seances <br />1. Impact on public health — Compliance component #1 of 5 <br />Compliance criteria: <br />System discharges sewage to the ❑ Yes' ® No <br />ground surface <br />System discharges sewage to drain ❑ Yes' ® No <br />tile or surface waters. <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. <br />Date: 6/25/2025 <br />Attached supporting documentation: <br />❑ Other: <br />❑ Not applicable <br />2. Tank integrity — Compliance component #2 of 5 <br />Compliance criteria: <br />System consists of a seepage pit, ❑ Yes' ® No <br />cesspool, d p rywell, 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 mailing to protect groundwater. <br />Attached supporting documentation: <br />® Empty tank(s) viewed by inspector <br />Name of maintenance business: Sewer Services <br />License number of maintenance business: 2502 <br />Date of maintenance: 6/25/2025 <br />❑ Existing tank integrity assessment (Attach) <br />Date of maintenance <br />(mm/dd/ <br />YYYY) (must be within thrPa vaarcl <br />(See form instructions to ensure assessment complies with <br />Minn. R. 7082.0700 subp. 4 B (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 inspection. Tanks are showing there age as the tanks are starting <br />to deteriorate do to Hydrogen Sulfide <br />https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-wwists4-32b • 412812021 <br />Page 2 of 4 <br />