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09-22-2021 Septic Compliance Report
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09-22-2021 Septic Compliance Report
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Last modified
8/22/2023 4:41:22 PM
Creation date
9/23/2021 2:23:33 PM
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Template:
x Address Old
House Number
300
Street Name
Stubbs Bay
Street Type
Road
Street Direction
North
Address
300 Stubbs Bay Road North
Document Type
Septic
PIN
3211823420005
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Updated
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1. Impact on public health — Compliance component #1 of 5 <br />System discharges sewage to the ❑ Yes* ® No <br />ground surface <br />System discharges sewage to drain ❑ Yes` ® No <br />tile or surface waters. <br />System causes sewage backup into ❑ Yes' ® No <br />dwellinc or establishment. <br />Any "yes" answer above indicates the system is an <br />imminent threat to public health and safety. <br />Describe verification methods and results: <br />Searched for surface outlet or ground discharge <br />Checked for back-up <br />Attached supporting documentation: <br />❑ Other: <br />® Not applicable <br />2. Tank integrity— Compliance component #2 of 5 <br />Compliance criteria: Attached supporting documentation: <br />System consists of a seepage pit, ❑ Yes' ®No ® Pumped at time of inspection <br />cesspool, drywell, leaching pit, <br />or other cit? <br />Sewage tank(s) leak below their ❑ Yes' ® No <br />designed operating depth? <br />If yes. which <br />Any "yes" answer above indicates the system <br />is failing to protect groundwater. <br />Describe verification methods and results: <br />Pumped & Inspected <br />Name of maintenance business: Sewer Services <br />License number of maintenance business: 2502 <br />Date of maintenance: 8/22/2021 <br />❑ Existing tank integrity assessment (Attach) <br />Date of maintenance <br />(mmidd/yyyy): (must be within three years) <br />(See form instructions to ensure assessment complies with <br />Minn. R. 7082.0700 subp. 4 8 (1)) <br />❑ Tank is Noncompliant (pumping not necessary—explain below) <br />❑ Other: <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 • 1/11/21 Page 2 of4 <br />
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