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t t <br /> . _ . Certificate of Abandonment <br /> Subsurface Sewage Treatment Systems <br /> ConrpJetet(/ornr nrusr be��uGncrried tivithrn 9f1 dnvs <br /> Reason for <br /> Date of Abandonment: 5-31-17 Abandonment: Instaliation of Multi-flo System <br /> Property <br /> Property Owner(s): Frederick& Karen Schmeisser Owner Phone #: <br /> Site Address: 755 Ferndale Rd N �ity: Orono Z�p; 55391 <br /> Fire #/Parcel ID #: 36-118-23-11-0028 County: Hennepin Township: <br /> This form is to be completed as verification of a septic tank abandonment. This form does not have to be <br /> completed by a certified SSTS practitioner, but must be compleCed by the individual who has knowledge of <br /> how the system was abandoned. Please include an as-built drawing showing location of <br /> abandoned septic tank(s)on the back of this form. <br /> To be in compliance, a system with no future intended use must be abandoned in accordance with MN R. <br /> Chapter 7080.2500. The criteria are provided on this form. <br /> Compliance Questions/Criteria <br /> Were all the salids and liquids removed* from the system? Yes No <br /> Were all electrical devices and devices containing mercury removed*? Yes No <br /> Were all underground tanks removed* �crushed or filled with soil or rock material? Yes No <br /> Were all underground cavities (i.e, chamber systems) removed*or fil{ed with soil or rock Yes No <br /> material? <br /> Was all access to future waste discharge permanently denied in accordance with the plumbing Yes No <br /> code(if applicable)? <br /> Was it determined if any contaminated soil (determined visually}was present at soil dispersal Yes No <br /> system or surrounding leaking tanks**? (I��y�s,gnr ro rrexr ques�io+�) <br /> Was all visually contaminated soil removed*? N/A Yes No <br /> **Tltrs is not n contpliance qeieslion, 1�u1 is�rsked�o determine iJa sc�back!n a i+�a/er stipply ire!!is needecl,fi•cmr Ihe <br /> nbandotted syslenr. <br /> *Removed maleriuls nu�,rr be c�isposed rn crccordance tivilh 7080.?500 sub��ar•13. lnrproper diaposal docs irot uf)'ect the <br /> cornplia�rce of tfre aba��dared system, brrl iiiaproper clisposal tivi/!be deult ivi�h iir a separafe cn%rcenrent uc�ion. <br /> Any"no"answer indicates that the system is failing to protect groundwater. <br /> I hereby certify the system was abandoned in accordance with MN Rule Chapter 7080.2500 and <br /> Hennepin County requirements. <br /> Name: Glen Kothrade- President(C2596) I Joel Schutte- Foreman (C7345) <br /> Business Name/Address: Kothrade Sewer, Water& Excavating <br /> 12059 Whitetail Ln, Hanover MN 55341 <br /> Date of Abandonment: �;� ��7,_� ��'1 <br /> Signature:- -�u�� .,�,���k`�ka,� <br /> �����Qs ������c���a� ,,,. <br /> HSI�HD °� <br /> ---, ,�.,��.�� <br /> ..�� <br /> T:IPHCS1ResUidedWHP_EH1Sep6c\SEPTICt2008-Certificate of A6andonmentdoc Ot12112014 <br />