3-27-20 Septic Cert - Laserfiche WebLink

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P address: 2425 Thoroughbred Lane (Colin & Julie Davie) Pati lD: 0411723110018 City. Orono _ state:_MN _ zip code-_ 55356 , optional section: Sewase, Tank Compliance Cer tRcadon This Mann does not represent a ccrrrplste system inspection report and only cerdfies sewage tank co apHanc a atatcae. lnstewWom This section 01 the form urey be aorrapieted and S% ed by a wed CoNad lndivldusl (DCI) of a licensed SSM Makdanom Susirmm who personalty conducts the nary procedcn+es to assess the cmVionce status of each sewage tank in the system. When this section of the tam is signed by a gjdfled cterd W prolesslonal, It beooates rreoMMy aaWof ft cimyrowltO rn to an ExIsWO &AMm CompNarm Inspection . This form can be found an the MPCA webafte at The Wilorm mon and certified sw*nent on this herrn is nquired when wasting septic tank compMance status a determined by an Individual other thea the SM inspedw that submits to inspectlon report. It represents a third party assessment of SSTS comp xm t cornpftwe end Is klioroable under Minn. R. 7082.0700. subp. 4 item (B) subitern (1). This Borne is valid for a period of three years beyond the d9nolum dale an this faun unless a raw evmkm#w Is requested by the uWW or ownwe aged Or is reeluired accordkV to local reguisfixt& Additional Adminishaadve Rule references for this ad vrty can be found at t4Mnr. R. 70<32.0700. subp_ 4 (tarns B. C, and D; 7083.0730 item C. ffi Cortilrau is of sswpe tank carnpll neer Attuned all aurae atetements: 19 The SM doss not amlala a seepage pit, cesspool, d ywelt, lescift pit or other pit. It does rat contain a sewage tank that was designed to be weberW, but subsecpaentiy leaks below the defined operating depth. it does not represent are Imminent sif* threat by reason of unsecured, damaged, or weak meirrbenarrce hews ae+ear(s} or ether unsafe candkcsrr. Company Wormration Company narrw A?bir's Septic Pumaine, LLC -- Business kwase number 3346 I—] Noike of sowgp tank none-cornpliancs Select A that appy [] The Stn has a seepage pit, cesspool, drywall, WwNng A or other pit. ® It hes a somal tank that was deemed 0 be woortlglw, btA subsaquentiy leaks below the designed d itltpresents a tWest to public ssliaty by reason of unsecui ed, damaged, or weak nasiiftr ence hole cover(s) or other unsafe condition. InIgnefied Cwd&W Individual (DCQ Informatlon Print name: Peter Peterson Certification number. 9227' I pdraa* aYar:dr,ded the weak dawdW abow ado a Desovted C tftd hxiiw&vl of a Afiw*sata-**►mad 3573 AUinl~essrace Bl ear. I per=,* OWxtWVtlne ry pm4raedr m its assess the carrrpftnce sM a creach sawap tank is f1M8 SETS: Designated CerOW Islgnatura: _ Dote (mm/dd/yy): Q5/2902019 www.pcLshft.fw.us • 651-2%-63trd • NO -07-3864 Use your pi eft , Mqr Servide ws-wwrf ft+3a • 1/27/17 • Avtrtlartrle in atternatNe fermate PtW3of3