08-19-19 Septic Compliance Report

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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 (MPCA) 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 (mm/dd/yyyy): 8/19/2019 ® Compliant — Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) ❑ Noncompliant — Notice of Noncompliance (See Upgrade Requirements on page 3.) ❑ 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: 0411723430014 Property address: 2770 Rainey Road, Wayzata, MN 55391 Reason for inspection: Property Transfer Property owner: Richard W or Owner's representative: Local regulatory authority of Orono Owner's phone: Representative phone: Regulatory authority phone: 952-249-4600 (2) 1000 gallon pre -cast septic tank, (1) 100 gallon pre -cast pump, and a 10x60 Rock bed with 12 Brief system description: inches of sand under rock. Comments or recommendations: Septic tanks we're pumped at the time of inspection and a camera was used to verify the tanks. 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: Pernel "Chip" Hentges Certification number: Business name: Ch6s_S_e_p1Xqervices LLC License number: Inspector signature: Phone number: Necessary or Locally Required Attachments ® Soil boring logs ® System/As-built drawing ❑ Other information (list): 2064 952-200-3176 ❑ Forms per local ordinance 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 • 3116112 Page 1 of 3