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Property address: 525 Femdale Road N,Orono Inspector initials/Date: JS I 5J10/2017 <br /> (mMdd/yyyy) <br /> 1. Impact on Publit Health—Compliance component#1 of 5 <br /> Com liance crfteria: Ve�ification method(s): <br /> System discharges sewage to the ❑Yes �No �Searched for surFace ouUet <br /> round surface. �Searched for seeping in yard/badcup in home <br /> System discharges sewage to drain ❑Yes �No ❑Excessive ponding in soil system/D-boxes <br /> tile or surfaoe waters. ❑ Homernmer testimony(See Comments/Explenatlon) <br /> System causes sewage badcup into ❑Yes �No ❑'Bladc soil"above soil dispersal system <br /> dwetling or establishment. <br /> ❑System requires°emergency"pumping <br /> Any"yes"an:wer above indfcates the ❑performed dye test <br /> system is an imminent threat to public ❑Unable to verify(See Comments/Enpianatlon) <br /> he�/th and safety. ❑Other me�'tods not(isted(See Comments/Explanatlon) <br /> CommenblExplana�on: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Com Ilance criteria: Verificatfon method(s): <br /> System oonsists of a seepage pit, �Yes ❑ No � Probed tank(s)bottom <br /> cesspool,drywell,or leaching pit. <br /> ❑Examined constnaction recoMs <br /> Seep�ge pits meedng�080.2550 may be ❑Examined Tank Integrity Form(Attach) <br /> com iarrt if albwed in loca/ordinanoe. <br /> Sewage ta�k(s)leak below their �Yes ❑No �Observed liquid level below operating depth <br /> designed operating depth. ��mined empry(pumped)tanks(s) <br /> If yes,which sewage tank(s)leaks: ❑ Probed outside tenk(s)for"black soii" <br /> Any "yes"answer above indicates the ❑ Unable to verify(Sse Comments/ExplenaHa►) <br /> system IS faJling to pl"oteCt 8roundwatel: ��her methods not listed(see commeMs/�icp/a►►atlon) <br /> Commer�ts/Explanation: <br /> Labeled as concrete blodc tanks on aty inventory record <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenar�ce hole oovers are damaged,cracked,unsecured,or appear to be stnx�uraily unsound. ❑Yes" �No ❑Unknown <br /> b. Other issues(elechica/hazaRis,etc.)to immediately and adversely impact public t�alth or safety. ❑Yes" �No ❑Unknown <br /> *System Is an Imminent threat to pubNc heslth and safety. <br /> Explain: <br /> a System is non-protedive of ground water for other oorxl�ions as determined by inspector. p Yes• �No <br /> "System is falNng M proLect�narndweber. <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651•282•5332 or 800-657-3864 • Available in altematfire famats <br /> w�q-wwFsts4•3f • 3/f6/f2 Page 2 of 3 <br />