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Property address: 2700 Copperview Drive. Orono. MN Inspector initials/Date J. 0. 9/02/16 <br /> 1. ImpaCt On PubliC Health —Compiiance component#1 of 5 <br /> Compliance criteria: Verification method�s): <br /> System d�scharge sewage to the ❑Yes � No � Searched for surface outlet <br /> ground 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 CommentsfExpianarion) <br /> System cause sewage backup into ❑ Yes � No � ��B�ack soil"above soil dispersai system <br /> dweiling or establishment. ❑ System requires"emergency°pumping <br /> ❑ Performed dye test <br /> Any"yes"answer above indicates the sysiem is ❑ Unabie to v@rify(See Comments/Explanation) <br /> an Imminent Threat to Public Health and Safety. ❑ Other methOdS nOt listed (See Comments/ExplanationJ <br /> Comments/Explanation: <br /> 2. Tank Int2g1'ity—Compliance component#2 of 5 <br /> Compliance 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(Attach) <br /> complrant if allowed rn locat ordinance <br /> ❑ Observed liquid level below operating depth <br /> Sewage tank(s) leak below their ❑ Yes � No <br /> deslgned operating depth. ❑ 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 ihe � Unable to verify(See Comments/Explanation) <br /> system is Failing to Protect Groundwater. ❑ Other methods not listed (See Comments/Explanat�on) <br /> Comments/Explanat�on: <br /> 3. Othe� COmplianCe Collditio�5—Compliance component#3 of 5 <br /> a. Maintenance hole covers are damaged.cracked,unsecured,or appear to structurally unsound. ❑Yes` �No O Unknown <br /> b Other issues(erectncal hazards etc.)to fmmediately and adversely impact public health or safety ❑Yes' �No ❑Unknown <br /> "System is an imminent threat fo public health and safety <br /> `xplair <br /> c System is non-protective of ground water for other condiUons as determ�ned by inspector ❑ Yes' � Nc <br /> 'Sysiem is failing to protect groundwater <br /> Cxplain <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-386a • TTY 651-282-5332 or BOQ•657-386a • Avaitable in alternative formats <br /> wq-wwists4•31 • 1114/12 Page 2 of 3 <br />