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POLL <br />CONTROL <br />AGENCY rloN Compliance inspection report form <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 />hf_[c'.s;tlwww.pca.state All P1us/sites/defaL11fl leslv�t ist 4-31a.l)df. <br />n... orrn w i_.. ai i,., . i ; G ' <br />,__ .., r as.,�. i... ..>.,t vat f,,. .ar <br />Property information Local tracking number: <br />Parcel ID# or Sec/Twp/Range: Local regulatory authority: Cityof Orono <br />Property address: 50 Wear Lane South, Orono <br />- - — <br />Owner/representative: Dave Hill Owner's phone: 612-978-7381 <br />Brief system description: 2 x 1000 gal septic, 1000 gal pump tank with an elevated trench system <br />- — — - - <br />System status -- <br />System status on date (mm/dd/yyyy): 4/21/2022 <br />❑ Compliant - Certificate of compliance* ® Noncompliant - Notice of noncompliance <br />(Valid for 3 years from report date unless evidence of An imminent threat to public health and safety (ITPHS) must be <br />an imminent threat to public health or safety requiring upgraded, replaced, or its use discontinued within ten months of <br />removal and abatement under section 145A.04, receipt of this notice or within a shorter period if required by <br />subdivision 8 is discovered or a shorter time frame exists local ordinance or under section 145A.04 subdivision 8. <br />in Local Ordinance.) <br />Systems failing to protect ground water must be upgraded, <br />`Note: Compliance indicates conformance with Minn. replaced. or use discontinued within the time required by local <br />R. 7080.1500 as of system status date above and ordinance. <br />does not guarantee future performance. <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 />Certification <br />I hereby certify that all the necessary information has been gathered to detennine 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, I certify the above statem of to be true and correct, to the best of my knowledge, and that this information <br />can be used for the purpose o p oce ng t is forme <br />Business name: Sewer S c nc e <br />- Certification number: C1659 <br />- - <br />Inspector signature - License number: 2502 <br />f This document has been electronically signed) Phone: 952-873-3292 <br />-- <br />Necessary or locally required supporting documentation <br />® Soil observation logs ® Locally required forms ® Tank Integrity Assessment ❑ Operating Permit <br />❑ Other information (list): <br />https://www.pca.state.mn.us 651-296-6300 • 800-657-3864 Use your preferred relay service • Available in alternative formats <br />wq-wwists4-31b • 1/11/21 <br />Page 1 of 4 <br />