11/01/2021 Septic Compliance - Laserfiche WebLink

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https://www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 1 of 4 Compliance inspection report form Existing Subsurface Sewage Treatment System (SSTS) Doc Type: Compliance and Enforcement Instructions: Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final determination of compliance or noncompliance. Instructions for filling out this form are located on the Minnesota Pollution Control Agency (MPCA) website at https://www.pca.state.mn.us/sites/default/files/wq-wwists4-31a.pdf. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: 04-117-23-31-0017 Reason for Inspection Transfer of property Local regulatory authority info: City of Orono, Hennepin County Property address: 2940 Fox Street, Orono, 55356 Owner/representative: Coldwell Banker - Andi Owner’s phone: 612-840-7791 Brief system description: 2 - 1300 gallon septic tanks and 1 - 1300 gallon lift tank to mound System status System status on date (mm/dd/yyyy): 11/1/2021 Compliant – Certificate of compliance* Noncompliant – Notice of noncompliance (Valid for 3 years from report date unless evidence of an imminent threat to public health or safety requiring removal and abatement under section 145A.04, subdivision 8 is discovered or a shorter time frame exists in Local Ordinance.) *Note: Compliance indicates conformance with Minn. R. 7080.1500 as of system status date above and does not guarantee future performance. Systems failing to protect ground water must be upgraded, replaced, or use discontinued within the time required by local ordinance. An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance or under section 145A.04 subdivision 8. Reason(s) for noncompliance (check all applicable) Impact on public health (Compliance component #1) – Imminent threat to public health and safety Tank integrity (Compliance component #2) – Failing to protect groundwater Other Compliance Conditions (Compliance component #3) – Imminent threat to public health and safety Other Compliance Conditions (Compliance component #3) – Failing to protect groundwater System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) – Failing to protect groundwater Soil separation (Compliance component #5) – Failing to protect groundwater Operating permit/monitoring plan requirements (Compliance component #4) – Noncompliant - local ordinance applies Comments or recommendations 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. By typing my name below, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this form. Business name: Ende Septic Service Certification number: L2654 Inspector signature: Tristan Ende License number: C9206 (This document has been electronically signed) Phone: 763-428-4489 Necessary or locally required supporting documentation (must be attached) Soil observation logs System/As-Built Locally required forms Tank Integrity Assessment Operating Permit Other information (list):