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Property address: 465 Hurrter Pass,Orono Inspector initials/Date: JS I 4/17/2017 <br /> (mm/dd/YYYY1 <br /> 1. Impact on Public Health—Compliance component#1 of 5 <br /> Com liance criteria: Verificatlon method(s): <br /> System discharges sewage to the ❑Yes �No �Seerched for surface outlet <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 ar surface waters. <br /> ❑ Homeowner testimony(See Comments/Explanation) <br /> System causes sewage badcup into ❑Yes �No ❑"Biadc soil"above soil dispersal system <br /> dwelling or establishmerrt. <br /> ❑System requires"emergency"pumping <br /> Any"yes"answer above indicates the ❑ per{ormed dye test <br /> system Is an immfnent threat to public ❑ Unable to verify(See Comments✓Explanatfon) <br /> health and safety. <br /> ❑Other methods not listed(Ses Comments/Explane�on) <br /> Comments/Explanation: <br /> 2. Tank Integrity—Compliance component#2 of 5 <br /> Com liance criteMa: Verif�ation method(s): <br /> System c�nsists of a seepage pit, ❑Yes � No ❑ Probed tank(s)bottom <br /> cesspool,drywelt,or leaching pit. <br /> �Examined construction records <br /> Seepage p;ts meehng 7080.2550 may be ❑ Examined Tank Inte n F <br /> r,ompliant iiallowed in Joce/wdinance. 9 �h+ orm(Attach) <br /> Sewage tank(s)leak below their ❑Yes �No �Observed liquid levei below operating depth <br /> designed 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 the ❑ Unable to verify(See Carnrrenfs/Explenetlon) <br /> sysiem/s fafling to protect groundwafer. ❑Other methods not listed(See Commerrfs/F�cplanation) <br /> Comments/Explanatfon: <br /> 3. Other Compliance Conditions—Compliance component#3 of 5 <br /> a. Maintenance h�e covers are damaged,cracked,unsecured�or appear to be structurally unsound. p Yes" �No Q Unknown <br /> b. Clther issues(elactri�al hazero►s,etc.)to immediately and adversely impact public health or safety. ❑Yes" �No p unknown <br /> *Sysrem!s an imminerrt threat to publlc health and safety. <br /> Explaf n: <br /> See notes on firs�page <br /> c. System is rwn-protecdve of ground water for other condi�ons as determi�ied by inspector. ❑Yes* �No <br /> *System Is fafJJng to prot�ect groundwater. <br /> Explain: <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Avallabte in altemative formats <br /> wq-wwrsts4-31 • 3/16/12 <br />