Laserfiche WebLink
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 /> <br />Compliance inspection report form <br />Existing Subsurface Sewage Treatment System (SSTS) <br />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.us/sites/default/files/wq-wwists4-31a.pdf. <br />Property information Local tracking number: <br />Parcel ID# or Sec/Twp/Range: 28-118-23-42-0007 Reason for Inspection Property Transfer <br />Local regulatory authority info: City of Orono <br />Property address: 1125 Pineview Dr Orono, MN 55356 <br />Owner/representative: Owner’s phone: 952-221-4952 <br />Brief system description: 2-1250 gallon septic tanks and a 1250 gallon pump tank. Effluent pumped to a pressure fed mound with a <br />1.8' sandlift and a 10'x63' rockbed. <br />System status <br />System status on date (mm/dd/yyyy): 7/27/2022 <br /> Compliant – Certificate of compliance* Noncompliant – Notice of noncompliance <br />(Valid for 3 years from report date unless evidence of an <br />imminent threat to public health or safety requiring removal and <br />abatement under section 145A.04, subdivision 8 is discovered or <br />a shorter time frame exists in Local Ordinance.) <br />*Note: Compliance indicates conformance with Minn. <br />R. 7080.1500 as of system status date above and does not <br />guarantee future performance. <br />Systems failing to protect ground water must be upgraded, replaced, or <br />use discontinued within the time required by local ordinance. <br />An imminent threat to public health and safety (ITPHS) must be <br />upgraded, replaced, or its use discontinued within ten months of receipt <br />of this notice or within a shorter period if required by local ordinance or <br />under section 145A.04 subdivision 8. <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 /> <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, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be <br />used for the purpose of processing this form. <br />Business name: Ende Septic Service Certification number: C9206 <br />Inspector signature: License number: L3654 <br /> (This document has been electronically signed) Phone: 763-428-4489 <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 />