06-16-2009 - Ltr re septic system on other Orono property that homeowner owns

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� : Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paui,MN 55155-4194 I nstructions on page 7 Parcel number: 27-118-23-44-0008 For Local Tracking Purposes: System status: ❑ Compliant � Noncompliant (based on all compliance requirements) Summary Form Property Information Property owner name(s): LUCILLE M OFFERMAN TRUSTEE Property address: 1669 NORTH FARM RD LONG LAKE MN 55356 Property owner's address(if different): Counry: Hennepin Property owner phone: Permitting authority: City of Orono Date system constructed: 1981? Reason for inspection: Real Estate Transaction System Description Brief system description: Septic Tank/Lift station/drainfield Local permit number: unknown Number of bedrooms: 3 Design flow rate: 450 Is the system: In Shoreland area? � Yes ❑ No In Wellhead Protection Area? ❑ Yes � No An U.S. Environmental Protection System serving a Minnesota Department Agency(EPA)Class V Injection Well?❑ Yes � No of Heath(MDH)licensed facility? ❑ Yes � No COI'T1P�1df1C@ $tdtUS (Based on state requirements—additional locai requirements may also apply.) Based on the information gathered and reported on attached forms,the compliance status of this system is(check one): ❑ Certificate of Compliance—valid until (3 years from date of report): � Notice of Noncompliance-For Noncompliant systems: The reason for noncompliance is: Rotted tank/missing baffle/surfacing drainfield This noncompliant system is classified as (check one below): � Imminent threat to public health&safety ❑ Failing to protect ground water ❑ Not in compliance with operating permit C@I"t1f1Cdt1011 (Completed form must be submitted to the local unit of government within 15 days.) 1 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. Name: Mark J Hayes Certification number: R5013 Business license name and number: Minnesota Geotechnical Services, LLC MPCA#L3203 or Name of local unit of government: Wright County Signature: M�/ �� Date: 6/16/9 Required Attachments Inspector Complete: This Inspection Report is 9 pages long. CheCk ComplianCe forms attaChed: �Hydraulic Performance �Tank Integrity ❑Soil Separation �Operating Permit Form(if applicable) �System drawing/As-built drawing ❑An assessment of any local requirements that are different from what is required on this form ❑Soil Boring Logs ❑Abandonment form(if appropriate) ❑Other information(list): UpgYBCI@ R@C�UI�QIII@IItS(d6�ived ffOm Minn. StBt.§115.55)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.If the system is failing to protect ground water,the system must be upgraded,replaced,or its use discontinued within the time required by local ordinance.If an existing system is not failing as defined in law,and has at least two feet of design soil separation,then the system need not be upgraded,repaired,replaced,or its use discontinued,notwithstanding any local ordinance that is more strict.This provision does not apply to systems in shoreland areas, Wellhead Protection Areas,or those used in connection with food, beverage,and lodging establishments as defined in/aw. wq-wwists4-31 Comp(ionce Inspection Form for Existing SSTS 4/4/08