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MINNESOTA POLLUTION Compliance inspection report form <br />CONTROL AGENCY N p <br />520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) <br />St. Paul, MN 55155-4144 Doc Type: Compliance and Enforcement <br />Instructions: Inspector must submit completed form to Local Governmental Unit (LGU') and system owner within 15 days of <br />final determination of compliance or noncompliance. Instructions for filling out this form are located on the Minnesota Pollution <br />Control Agency (MPCA) website at https://www.pca.state.mn.usisites/default/files/wq-wwists4-31a.pdf, <br />Property information Local trackino number <br />Parcel ID# or SecfTwp/Range: 36-118-23-14-0008 Reason for Inspection Transfer of property <br />Local regulatory authority info: City of Orono, Hennepin County <br />Property address: 519 Ferndale Rd N, Wayzata, MN 55391 <br />Owner/representative: Dennis Krumsieg Owner's phone: 612-532-2284 <br />Brief system description: 3 - 1000 gallon septic tanks, to a pressure fed mound system with a 20 inch sand lift and a 1Ux50' rockbed <br />System status <br />System status on date (mm/dd/yyyy): 6/2/2021 <br />® Compliant — Certificate of compliance* ❑ Noncompliant — Notice of noncompliance <br />(Valid for 3 years from report date unless evidence of an Systems failing to protect ground water must be upgraded, replaced, or <br />imminent threat to public health or safety requiring removal and use discontinued within the time required by local ordinance. <br />abatement under section 145A.04, subdivision 8 is discovered or <br />a shorter time frame exists in Local Ordinance.) An imminent threat to public health and safety (ITP! IS) must be <br />upgraded, replaced, or its use discontinued within ten months of receipt <br />*Note: Compliance indicates conformance with Minn. of this notice or within a shorter period if required by local ordinance or <br />R. 7080.1500 as of system status date above and does not under section 145A. 04 subdivision B. <br />guarantee future performance. <br />Reason(s) for noncompliance (check all applicable) <br />❑ Impact on public health (Compliance component #1) — Imminent threat to public health and safety <br />❑ Tank integrity (Compliance component #2) — Failing to protect groundwater <br />❑ Other Compliance Conditions (Compliance component #3) — Imminent threat to public health and safety <br />❑ Other Compliance Conditions (Compliance component #3) -- Failing to protect groundwater <br />❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) — Failing to protect groundwater <br />❑ Soil separation (Compliance component #5) — Failing to protect groundwater <br />❑ Operating permit/monitoring plan requirements (Compliance component #4) — Noncompliant - local ordinance applies <br />Comments or recommendations <br />Certification <br />i hereby certify that all the necessary information has been gathered to determine the compliance status of this system No determination of <br />future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, <br />inadequate maintenance, or future water usage. <br />By typing my name below, 1 certify the above statements to be true and correct, to the best of my knowledge; and that this infonnation can be <br />used for the purpose of processing this form. <br />Business name: Ende Septic Service, LLC Certification number: L2654 <br />Inspector signature: Tristan Ende License number: C9206 <br />(This document has be n electro ' e Phone: 76328-4489 <br />Necessary or locally required supporting documentation (must be attached) <br />® Soil observation logs ® System/As-Built ❑ Locally required forms ❑ Tank Integrity Assessment ❑ Operating Permit <br />❑ Other information (list): <br />https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-wwists4-31b • 4/28/2021 Page 1 of 4 <br />