05-28-20 Septic Compliance Inspection

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O.A.Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SETS) St. Paul, MN 55155-4194I 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): 5/28/2020 ® Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) ❑ Noncompliant- Notice of Noncompliance (See Upgrade Requirements on page 3.) 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 permittmonitoring plan requirements (Compliance Component#5) — Noncompliant Property Information Parcel ID# or Secfrwp/Range: Property address: 4565 Bayside Road Reason for inspection: Sale Property owner: Tim & Mary Doubek Owner's phone: 612-801-3076 or Owner's representative: Local regulatory authority: Brief system description: Representative phone: City Orono Regulatory authority phone: 2- 1250 gallon septic tanks with 1250 pal pump tank & a mounds stem Comments or recommendations: The design has 4 different numbers for the sand depth of the mound, each page says something different. I went 24" on boring with no redox so mound will pass no matter which number was correct 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 S es I e! License number: 2502 Inspector signature: - 0OOk 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 or800-657-3864 • Available in alternative formats wq-wwists4-31 • 3/16/12 Page 1 of 3