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. Property addtes�: 2755 Cpuntryaide D�ive W,Orono,MN Inspedor ini�a{s/Uate: J.0.6116117 <br /> 1. Impact on Public Heatth—Complianc:e component�9 of 5 <br /> Com Hance crits�: Veritication metbod(s): <br /> System discharge sewrage to the ❑Yes �No � �fd►ed for surface outlet <br /> round surtece. � Searched for seeping in yardJbadcup in home <br /> S tem disc�a ❑ ��i��p�ing in aoil aystem/D-boxes <br /> ys rge sewage to drain Nle ❑Yes �No <br /> or surface wate�'s. � ❑ Homeovmar teatimany{See Canments/Expanabon) <br /> ❑ "B�ack soil•abo�re soil ai�persa�systerr, <br /> System cause sewage badcup iMo � ❑Yes �No ❑ System r�ui�es"emergency"pumping <br /> dwelling or e�ahiishmsnt. <br /> Any"yes"enswer above fndicai+es the syslem Is ❑ PerFom�eci dye teat <br /> ❑ Unable to verify(See CorrunenralEacplanatbn) <br /> an Immfneni Thre�t tar P�blic Haa/th and Safety. ❑ p�,�m���s not listsd(See camrr�er►rsr�icpra�arronl <br /> CommerrtslE�lanation: <br /> 2. Tank integrity—Compiiance componant�Z of 5 <br /> Compliance c�teri�: VeMflcatian method{s): <br /> Syatem consists of a seepage pit, ! ❑Yes �Mo ❑ Probed tank(s)bottom <br /> cesspooi,drywell,or I�c�ing pit. � <br /> ; p Ex�mined oonstrudion r�corrls <br /> �����7�•���Y� ( ❑ Examined Tank Integrity Fonn(Attad,) <br /> c�m ant ii aaowrd ire bcal ' �9 p <br /> ❑ Observed liquid levei below o�ra d� th <br /> Sewage tank(s)leak below their ❑Yes �No ❑ �mined empty(Purnped)tanks(s) <br /> de ' ned o ti d+� . <br /> If yes,which sewage tank(a)leaks: ❑ P����nk(s)for"bladc soil" <br /> ❑ Uneble to veMy(See Commer�ts/ExPdeRe�y <br /> A�iy",)I�S"8/iiW6O�bOY81�J�Ci�t6i�Nl@ �Other methods n�t iisted(See CammsMsl�xplenatlaa) <br /> syy�stt�em Is Failing to Prot�ct Gr+ourta�vat�r: <br /> commencslExplanation: <br /> Peterson Company pumped the tanks. <br /> 3. Other Com tiance Gonditions—Compiianoe cflmponent#3 of 5 <br /> a. AAaint�arwe t�e cnvers are damagad,cxaciced,unsecurod,or�pear to sUtu�turalnr unsound. ❑Yes" �No ❑Urd�nonrn <br /> b. Otl��ssuea(elacMca►hazer�a.e�c.)to immediately and ad�►imP�P�����safetY. ❑Y�" i�No ❑uNcnown <br /> "�yat�»!s s»lmm/na�!fhn�t fo pubr�iN�Ndl�d ssfi�[y <br /> Expiain: <br /> c• System�norrpr�of ground vwater�other oonc�tions a�tletetmir�d bY Mspecxor ❑Yes• �No <br /> `Sy�am fs faiNi�g M prol+�ct�Oun�r <br /> Explsin: <br /> www.pcastate.mn.us • 651-296-6300 • 800-657-3364 . TTY 651-282-5332 ar&f0-657•38b4 . Avaiiable in attemative formats <br /> W!1-wwlsts4-31 . 1/2t/i? ^ - -- <br />