05-03-2023 Septic Compliance Report

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M�MINNESOTA POLLUTION Compliance inspection report form CONTROL AGENCY 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) St. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached supporting documentation — additional local requirements may also apply. Further information can be found here: https://www.pca.state.mn.us/sites/default/files/wg-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 Parcel ID# or Sec/Twp/Range: 3611823130012 Property address: 511 Ferndale Road N, Orono Owner/representative: Mark & Barb Capece Brief system description: 2- 1000 Gal. Septic tank, 1000 System status System status on date (mm/dd/yyyy): 5/3/2023 ® Compliant — Certificate of compliance* Local trackina number: Local regulatory authority: Henn (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. Owner's phone: 612-325-6420 tank, and mound. ❑ Noncompliant — Notice of noncompliance 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. 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 At the time of inspection the home was occupied and the septic system was in use. Everything was found to be in proper operating condition. 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: Miller's Inspector signature: Jei e Treatment Solutions Georae (This document has been electronically signed) Certification number: 7485 License number: 1921 Phone: 320-398-2705 Necessary or locally required supporting documentation (must be attached) ® Soil observation logs ® Other information (list): additional septic info. ® Locally required forms ❑ Tank Integrity Assessment ❑ Operating Permit https://www.pca.state.mn.us 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats wq-wwists4-31b • 1/11/21 Page 1 of 4