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Property address: 145 S. Brown Rd. Orono _ Inspedor�/pate: I�A_M. � 725r1017 <br /> _ ���� <br /> _1. Impact on Public Health—Compliance componerrt#1 of 5 <br /> Compliance criteria: _ Veriflcatlon method(s): <br /> System discharges sewage to the ❑Yes � No �Searched for surface outlet <br /> ground surtace. _ � Searched for seeping in yard/ba:.kup in home <br /> System discharges sewage to drain � ❑Yes � No ❑ Excessive ponding in soil syster /D-boxes <br /> tile or surface waters. ; <br /> --�— � Homeowner testimony(See Com•rrents/Explanstion) <br /> System causes sewage backup into ; ❑Yes � No ❑�Black soil"above soil dispersal yystem <br /> dwelling or establishment. <br /> - ' --- ❑System requires"emergency"pumping <br /> Any"yes"answer above indicates the ❑ Performed dye test <br /> system is an imminent ihreat to public ❑ Unable to verify(See Comments/E:rplanarion) <br /> hea/th and safety. ❑pther methods not listed (See Ccmments/Explana6on) <br /> Com ments/Explanation: <br /> ''s <br /> _2. Tank Integrity—Compliance component#2 of 5 <br /> Compliance crite�ia: Verification method(s): <br /> System consists of a seepage pit, , ❑Yes � No � Probed tank(s)bottom <br /> cesspool,drywell,or leaching pii. <br /> � Examined construction records <br /> Seepege pits meeting 7080.2550 may be , ❑ Examined Tank Integrity Form(A�tech) <br /> complient N e1/owed in locel ordinance <br /> Sewage tank(s)leak below their ��Yes � No ❑Observed liquid level below oper�ting depth <br /> designed operating depth. ❑ Examined empty(pumped)tank�:s) <br /> If yes,which sewage tank(s) leaks: � Probed outside tank(s)for"black soil" <br /> Any "yes"answer above indicates ihe ❑ Unable to verify(See Comments/E�planation) <br /> system is failing to protect�roundwater. ❑Other methods not listed(See CornmentsiExplanation) <br /> C om ments/Exp l a nati o n: <br /> � <br /> 3. Oth@�CO�T1p118110E ConditlonS—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged,c.�acked,unsecured,or appear to be strudurally unsound. ❑ti�,s• �No ❑unknown <br /> b. Other issues(e/ecxrical hsza�ds,etc.)to immediately and adversely impad public heafth or safety. Q tias• �No ❑Unknown <br /> *Syst+em!s an imminent threat to publfc healih and safety. <br /> Exptaln: <br /> c. System is non-protedive of ground water for other oonditions as determined by inspedor. Q Yes� ;�No <br /> *System is failing to protect groundwater. <br /> Explain: <br /> � <br /> • www.pca.state.mn.us . 651-2%-63W • B0�-657-3664 • TTY 651-282•5332 or 800-657-3664 • Available in altemative formats <br /> wq-wwists4-31b • 6/4/14 Poqe 2 of 3 <br />