HomeMy WebLinkAbout 9-7-2020 Pumping Report & Tank Compliance2020 SEPTIC MAINTENANCE REPORT
Site address: 1150 Wyndmere Rd Orono, MN 55391 ( Jeff & Sheila Kruesel )
Number of tanks: Date fast pumped: 09C 17/2020 Gallons pumped: 3100
Name of pumper/ maintenance provider: Albin's Septic Pumping, LLC
Are tanks watertight?:
Is the system functioning property? Yes
YES NO
(please circle one)
(ie slow drainage, wetness in the drainfield?)
Do you have any specific concerns or issues that you'd like to discuss with the SSTS Program Manager?
No
If so, please indicate best time and telephone number{s} to be reached between 8 am and 4:30 pm.
Best Times
ROGER PEITSO
CITY" OF ORONO
PO BOX 66
CRYSTAL BAY MN
Telephone Number(s)
RETURN IN THE ENCLOSED ENVELOPE
AS SOON AS POSSIBLE
55323-0066
Property address: 1150 Wyndmere Rd Jeff .& Sheila Kruesel Parcel iD:26-115-23-41-(x.13
City: .Orono State: MN _ Zip code._ 55391
Optional section: Sewage Tank Compliance Certification
This form does not represent a complete system inspection report and only certifies sewage tank compliance status.
Instructions: This section of the form may be Meted and signed by a CertifiedDesignated once statuses dividual lOf a licensed SSTS
each sewage tank S
Maintenance Business who personally conducts the necessary proceduresto agnate the co
the system.
When this section of the forrm is sued by a qualified certified professional, it becomes necessary supporting dock to an
Existing System Compliance Inspection Report: Cor€cllance €nspect€om form Existimsystem [�+vo-unuieIs431 b1. This form ran be
found on the MPCA website at WU l,'wwrM.nca. _ stn -ander - i $ - p€I ceteris.
The Information and cid statement on this form is required when existing septic tank compliants status is determined by an
indhhddual other than the SSTS inspector that submits the inspection report. It represents a third party assessment of SSTS
component compliance and is allowable under Minn. R. 7082.0700, subp. 4 Item (B) subitem (1). This Than is valid for a period of
three years beyond the signature data on this form unless a new evaluation Is requested by the owner or owners agent or is
required according to local regulations. Additional Administrative Rule references for this activity can be found at Minn.
R. 7082.0700, subp. 4 Items B, C, and D; 7083.0730 Item C.
X Cemftate of she tank compliance
Affirm all three statements:
$ The SSTS does not contain a seepage pit, cessID001,
drywwell, leaching pit, or other pit.
it does not contain a sewage tank that as de the ed
to be wvatetlght, but subsequently teaks
designed operating depth.
j� it does not represent an Imrninent safety threat by
reason sof unsawred, damaged, or weals
maintenance hole cover(s) or other unsafe eondit€on.
Company information
Company name: Aibuo's Se'c Pumping, LLC
Business license number: 3348_—_
0 Notice of sewage tank non-compliance
Sated all that apply:
The SSTS has a seepage pill, cesspool, drywell,
leaching pit, or other pit.
it has a sewage tank that was designed to be
watertight, but subsequently leaks below the designed
operating depth.
❑ It presents a threat topublic safety by reason of
unsecured, darwaged. or weak maintenance hole
cover(s) or other unsafe condition.
Designated CoMfled Individual (DCQ Information
Print name: Peter Peterson
Certification number. 9227
I personally conducted the work described above as a Designated Certified Individual of a MinnesOla-fide"s9d SSTS Makdenance
Business. I personally oo xkx; sd ft uy pmcerlums to assess the compliance status of each sewage tar* in this SSTS.
Designated Certified 0910712020
Indlviduars signature: ! �_ Date (nrwmlddlyyyy): --
wwvw.pca.state.mn.us r • 551.296-5300 800-557.3854 Lise your preferred relay service
wq-wwwfsts4-38 • 1/27117
• Available in dtemative formats
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