HomeMy WebLinkAbout01/26/2021 Pumping Report and tank Certification2021 SEPTIC MAINTENANCE REPORT
Site address: 40 Truffula Trail (Luis & Veronica Acosta)
Number of tanks:
3 Date last pumped: 01 /26/2021 Gallons pumped: 2350
Name of pumper/maintenance provider: Albin's Septic Pumping LLC
Are tanks watertight?:
8 No
please circle one)
Is the system functioning properiy? Yes
(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 Telephone Number(s)
RETURN IN THE ENCLOSED ENVELOPE
AS SOON AS POSSIBLE
Alicia Johnson
CITY OF ORONO
PO Box 66
CRYSTAL BAY MN 53323-0066
Property address: 40 Trufula Trail (Luis & Veronica Acosta parcel 1o: 33_118-23-44-0035
city: Orono ._ .. — state: MN _ zip code:_5535§
Optional section: Sewage Tank Compliance Certification
This form does not represent a complete system inspection report and only cartiflies smgge tank compliance status.
lnstrr dons: This section of the form may be completed and signed bsks sass the complianceiied Individual
(D tof a each slicensed
a tank
Maintenance Business who personally conducts the necessary procedures
in
the system.
When this section of the form is signed by a qualified certified professional, it becomes neeessery sum documentatbn to an
Existing System Compliance inspection Report: Tian n Than - FAsjnQ MM= This form can be
found on the MPGA website at n jh w v . te-mn-ma&aLe rxi pis technical-and-0ornali�nte The information and certified statement on this form is required when existing septic tank compliance status is determined by an
1ndlvidual other than the SSTS Inspector that submits the inspection report. It represents a third party assessment of SSTS
component compliance mil is allowable under Minn. R. 7082.07D0, subp. 4 item (B) subitem (1). This form is valid for a period of
three yean3 beyond the signature date on this form unless a new evaluation is requested by the owner or owner's 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 sterns B, C, and D: 7083.0730 item C.
]gCwtificsts of sewage tank compliance
Aifrm all three statements:
]� The sSTS does not contain a seepage pit, cesspool.
dryweil, leaching pit, or other pit.
Jg It does not contain a sewage tante that was designed
to be watertight, but subsequently leases below the
designed operating depth,
It does rust represent an imminent safety threat by
reason of unsecured, damaged, or weak
maintenance hole cover(s) or other unsafe condition.
Company Informiation
Company name: Albin°s Septic Pumping, -LLC
Business Ik erm number: 3346 _T__
❑ Notice of sewage tank non-compliance
Select ail that apply:
E] The 'SSTs hes a seepage psi, cesspool, drywall,
teaching 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, damaged, or weak maintenance hflie
cover(s) or other unsafe condition -
Designated Certified Individual (DCI] Inforrnatlon
Print name: Peter Peterson_
Certification number: 9227
I persmnak"y conducted the mrk descni#ed above as a oesignated Ceitftd Iron oduaf of a Mhvsdta-Iikensed SSTS Maim`Wawe
Business. l,persornatly aondacted the ry procedures to assess the compliance status of each sewage tank in this SSTS.
Designated Certified 01/26/2021
Individuars signature: Date (rrFmlddlyyyy);
www.m.state.mn.us
wq-ww)sts4-38 • 1127117
651-246.6300 • 800.657-3864
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