04-19-2021 Septic Compliance Inspection

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MINNESOTA POLLUTION Compliance inspection report form �� CONTROL AGENCY Existing Subsurface Sewage Treatment System (SSTs) szo Lafayette freed worth St. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency (MPGA) requirements and attached supporting documentation — additional local requirements may also apply. Further information can be found here: httos://www.pca.state.mn.us/sites/defauIt/files/wq-wwists4-31 a.pdf- Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final determination of compliance or noncompliance. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: 3311823430023 Local regulatory authority: City of Orono Property address: 140 Golden View Dr Orono, MN - - Owner/representative: Chris Hickok _ Owner's phone: 6_12-419-9070 - Brief system description: 2-1000n septic tanks, 1000on�umptank toa pressure fed mound Gvctpm ctatus System status on date (mm/dd/yyyy): 4/19/2021 ® 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. Reason(s) for noncompliance (check all applicable) 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. Systems failing to protect ground water must be upgraded, replaced, or use discontinued within the time required by local ordinance. ❑ 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 Se t Service Certification number: C9206 Inspector signature: License number: L2654 (Thi umen'L.e ronically signed) Phone: 763-428-4489 Necessary or locally required supporting documentation (must be attached) ® Soil observation logs ❑ Locally required forms ❑ Tank Integrity Assessment ❑ Operating Permit ❑ Other information (list): https://www-Pca.state.mn.us wq-wwists4-31b • 1/11/21 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats Page 1 of 4