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Property address: 2755 Copper View Dr, Orono Inspector initials/Date: RGP 3/17/14 <br /> 1. Impact on Public Health-Compliance component#1 of 5 <br /> Co�liance criteria:_ _ Verification method(s): <br /> System discharge sewage to the ❑ Yes � No � Searched for surface outlet <br /> round surface. � Searched for seeping in yard/backup in home <br /> System discharge sewage to drain tile ❑ Yes � No ❑ Excessive ponding in soil system/D-boxes <br /> or surface waters. ❑ Homeowner testimony (see Comments/Explanation) <br /> ❑ "Black soil"above soil dispersal system <br /> System cause sewage backup into ❑ Yes � No <br /> dwelling or establishment. ❑ System requires"emergency"pumping <br /> — -- ❑ Performed dye test <br /> Any"yes"answer above indicates the system is ❑ Unable to verify (See Comments/Exp/anation) <br /> an Imminent Threat to Public Health and Safety. <br /> ❑ Other methods not listed (See Comments/Exp/anation) <br /> Comments/Explanation: <br /> 2. Tank Integrity-Compliance component#2 of 5 <br /> Com liance criteria: Verification method(s): <br /> System consists of a seepage pit, ❑ Yes � No ❑ Probed tank(s)bottom <br /> cesspool, drywell, or leaching pit. � Examined construction records <br /> Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Form (Artach) <br /> com liant it allowed in local ordinance. <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s) leak below their ❑ Yes � No <br /> desi ned o eratin de th. ❑ Examined empty(pumped)tanks(s) <br /> If yes, which sewage tank(s) leaks: ❑ Probed outside tank(s)for"black soil" <br /> Any "yes"answer above indicates the ❑ Unable to verify (See Comments/Exp/anation) <br /> sysfem is Failing to Protect Groundwater. � Other methods not listed (See Comments/Explanation) <br /> Comments/Explanation: baffles in place, effluent levels good, Pump and alarm function. <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 ❑unknown <br /> b. Other issues (electrical hazards,erc.)to immediately and adversely impact public health or safety. ❑Yes* � No ❑ Unknown <br /> `System is an imminent threat to public health and safety <br /> Explain: <br /> c. System is non-protective of ground water for other conditions as determined by inspector ❑Yes' �No <br /> 'System is failing to protect groundwater <br /> Explain: <br /> www.pca.state.inn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in atternative formats <br /> wq-wwists4-31 • 1/24/11 Page 2 of 3 <br />