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Property address: 465 HuMer Pass,Orono Inspector initials/Date: JS_ ( 4/17/2017 <br /> (mm/dd/yYri) <br /> 1. Impact on Public Health—Compliance component#1 of 5 <br /> Com Ifance criterta: Veriflcatlon method(s): <br /> System discharges sewage to the ❑Yes �No �Searched for surface outlet <br /> round surtace. �Searched for seeping in yard/bacacup in home <br /> System discharges sewage to drain ❑Yes � No ❑Excessive ponding in soil systemlD-boxes <br /> tile or surface waters. <br /> ❑Homeowner testimony(See Comments/Exp/anstion) <br /> System causes sewage badcup into ❑Yes �No ❑"Biadc soil"above soil dispersal system <br /> dweifing or establishment. <br /> ❑System requires°emergency"pumping <br /> Any"yes"answer above indicates the ❑performed dye test <br /> system is an Imminent threat to public ❑ Unable to verify(See Comments/Exp/enation) <br /> heatfh and safety. <br /> ❑Other methods not listed(Ses Comments/Explanaaon) <br /> Comments/Explanation: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Com 8ance criterfa: Verifi�ation method(s): <br /> System consists of a seepage pit, ❑Yes � No ❑ Probed tank(s)bottom <br /> cesspool,drywel(,or leaching pit. <br /> � Examined construction records <br /> Seepage pits meebrrg 7080.2550 may be ❑ F�camined Tank integrity Form(Attach) <br /> c�om liant if alJowed in loca/ordinance. <br /> Sewage tank{s)leak below their ❑Yes �No �Observed liquid level below operating depth <br /> designed operating depth. � Examined empty(pumped)tanks(s) <br /> If yea,which sewege tank(s)leaks: ❑ Probed outside tank(s)for"black soil" <br /> Any"yes"answer above indicates the ❑ Unable to verify(See Comments/ExplenaHon) <br /> system is failing to protect groundwater. ❑Othsr methods not listed(Ses CommentsiExptanation) <br /> Comme�ts/Explanatfon: <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Mairrtenance hole aovers are damaged,craGked,unsecured,a�appear tc be structurally unsound. ❑Yes" �No Q Unknown <br /> b. Clther issues(electr�ca►hezerds,etc.)to immediately and adversely impact public health or safety. ❑Yes" �No p unknown <br /> *System is an imminent threat to perbllc health and saNetty. <br /> Explain: <br /> See notes on first page <br /> c. System is non-protective of ground water for other conditions as determined by inspector, ❑Yes* �No <br /> '�ystem!s fafling to probect groundwater. <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Avallable in alternative formats <br /> wq-ww►sts4-3 t • 3/16/12 _ <br />