10-22-19 Septic Compliance Inspection Form

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Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155 4194 Doc Type:Compliance and Enforcement Inspection results based on Minnesota Pollution Control Agency(MPGA) For local tracking purposes: requirements and attached forms-additional local requirements may also apply. Submit completed form to Local Unit of Government(LUG)and system owner within 15 days System Status System status on date(mmidd/yyyy): 10/22/2019 ® Compliant— Certificate of Compliance I I Noncompliant— Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) ❑ Impact on Public Health (Compliance Component#1)-Imminent threat to public health and safety ❑ Other Compliance Conditions(Compliance Component#3)-Imminent threat to public health and safety ❑Tank Integrity(Compliance Component#2)-Failing to protect groundwater ❑ Other Compliance Conditions(Compliance Component#3)-Failing to protect groundwater ❑ Soil Separation (Compliance Component#4)-Failing to protect groundwater ❑ Operating permit/monitoring plan requirements(Compliance Component#5)-Noncompliant Property Information Parcel ID#or Sec/Twp/Range: Property address: 140 South Brown Rd, Orono Reason for inspection: Sale Property owner: Kevin Stanek Owner's phone: 952-240-7684 or Owner's representative: Representative phone: Local regulatory authority: City Regulatory authority phone: Brief system description: 2- 1000 gallon septic& 1000 gallon pump tank,with a mound system Comments or recommendations: There are 2 holes at the base of the mound that could be from animals or old stumps rotting away. They both should be filled with dirt to prevent a possible leak from forming at the base of the mound. There is no sign of leaking at this time,this is just a prevenative recommendation Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Josh Swedlund _ Certification number: C1659 Business name: Sewer Services Inc. / License number: 2502 Inspector signature: _ -/- - Phone number: 952-873-3292 Necessary or Locally Required Attachments ® Soil boring logs ® System/As-built drawing ® Forms per local ordinance ❑ Other information (list): www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 3/16/12 Page 1 of 3