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r N POLLUTION <br />CONTROL <br />AGENCY Compliance inspection report form <br />it CAGENCY <br />520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) <br />St. Paul, MN 55155-4194 <br />Doc Type: Compliance and Enforcement <br />Instructions: Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached supporting <br />documentation - additional local requirements may also apply. Further information can be found here: <br />hth,5 !/v vv� pra.state.nu�.uslsites/default/files/wq-wwisis4-31a ndf. <br />Inspector rrlust submit completed form to Local Governmental Unit (LGU) and system owner within '15 days of final <br />clete"In ination of cornpli ince or noncon'rpiiancc. <br />Property information <br />Local trackin number: <br />Parcel ID# or Sec/Twp/Range: Local regulatory authority: City of Orono <br />Property address: 591 North Stream Road, Orono - - ------ ------------ <br />Owner/representative: Sue Pearce <br />_ - - - - - -_ ._-..-_------ -- -- <br />---------- ----_.__...... .._ Owner's phone: 952-473-2735 <br />Brief system description:•2- 1000 gallon_septic tanks & rock trench drainfieid <br />System status <br />System status on date (mm/dd/yyyy): 4-28-2022 <br />❑ Compliant- Certificate of compliance` <br />(Valid for 3 years from report date unless evidence of <br />an imminent threat to public health or safety requiring <br />removal and abatement under section 145A.04, <br />subdivision 8 is discovered or a shorter time frame exists <br />in Local Ordinance.) <br />*Note: Compliance indicates conformance with Minn. <br />R. 7080.1500 as of system status date above and <br />does not guarantee future performance. <br />® Noncompliant- Notice of noncompliance <br />An imminent threat to public health and safety (ITPHS) must be <br />upgraded, replaced, or its use discontinued within ten months of <br />receipt of this notice or within a shorter period if required by <br />local ordinance or under, section 145A.04 subdivision 8. <br />Systems failing to protect ground water must be upgraded, <br />replaced, or use discontinued within the time required by local <br />ordinance. <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 />There is some degredation around the pipes in the 2nd tank from Hydrogen Sulfide damage, it is not exposing any rebar so it <br />doesn't cause the tanks to fail compliance <br />Certification <br />l hereby certify that ail the necessary information has been gathered to determine the compliance status of this system. No <br />determination of future system performance has been nor can be made due to unknown conditions during system construction, possible <br />abuse of the system, inadequate maintenance, or future water usage. <br />By typing my name below, / certify the above statements to be true and correct, to the best of my knowledge, and that this information <br />can be used for the purpose ofprocessing this form. <br />Business name: Sewer Ice Certification <br />irlc' , <br />Inspector signature: fication number. C1659 <br />_ <br />— - License number: 2502 <br />This documentiias been ele ironically signed) _ <br />Phone: 952-873-3292 <br />Necessary or locally required supporting documentation (rntlst he attached) - <br />® Soil observation logs ® Locally required forms <br />® Tank Integrity Assessment El Operating Permit <br />❑ Other information (list): <br />hops://www.pca.state.mn,us 651.296.6300 • <br />wq-wwisrs4-31b • 1111121 800.657-3864 Use your preferred relay service <br />Available in alternative formats <br />n­...r„ <br />