Septic info - Laserfiche WebLink

Home Browse Search

� �� t� '��eS°�a �°"u��°� Compliance Inspection Form �� Control Agency 520 Lafayette Road Nortt� Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155-4194 Dec 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}: 7(10/2014 � Compliant — Certificate of Compliance ❑ Noncompliant — Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) frame ouflired in Local Ordrnance.) Reason(s) for noncompliance (check alI appiicable) ❑ Impact on Public Health (Compliance Component#1)-Imminent threat to public hea(th and safety ❑ Other Compliance Conditions(Compliance Componeni#3)-Imminent threat to puhlic health and safety ❑ Tank Integrity(Compliance Component#2) -Failing to protect groundwater ❑ Other Compliance Conditions(Compliance Component#3) -Farling to protect groundwater ❑ Soil Separation (Compliance Component#4) -Failing to piotect groundwater ❑ Operating permit/monitoring plan requirements (Compliance Component#5)-Noncompliant Property Information Parcel ID#or Sec/Twp/Range: 06-117-23-22-0021 __ Property address: 4755 Bayside Road, Orono MN 55359 Reason for inspection: property transfer . __— _ Property owner. Owner's phone: or _. Owners representative: Coldweil Banker Burnet-Terri Danielson Representative phone: 763-684-4931 . _ _ --- �ocal regulatory authority: City of Orono Regulatory authority phone: __ Brief system description: 1250g1 septic tank, 1000g1 septic tank, 1250g1 pump tank, Mound system Comments or recommendations: At the time of i�spection the home sat vacant so water was ran from the house through the septic system to see how it performed. The system was found to be in proper operating condition. Certification 1 hereby certify that all the necessary informafion has been gathered to determine ihe compiiance status of this system. No determination of fufure system performance has been nor can be made due to unknown conditions during system consiruction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Jeremy George Certification number: 7485 __ __ _ ___ --.. Business name: Miller's Sew �tmenf S�I�s License number: 1921 _ __ __ . -- -- ---- r�- Inspector signature: {,� - �-�--- ___ Phone number. (320) 398-2705 _ _ � _ hlecessary or Local( equired Attachments � Soil boring logs �System/As-built drawing � Forms per local ordinance � Other information (list): Add. Septic Infa. __ __ _- __ _-_ _. ._ _ www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 � Available in alternative formats wq-wwists4-31 • 3/tb/12 Page f of 3