HomeMy WebLinkAbout08/15/2022 Septic Maintenance Report2022 SEPTIC MAINTENANCE REPORT
Site address: 1300 French Creek Drive ( Deb Hopp ) T —
Number of tanks: 3 _ Date East pumped: 08/15/2022 Gallons pumped: 1500
Name of pumper / maintenance provider: Albin's Septic Pumping, LLC
Are tanks watertight?:
Is the system functioning properly? 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 SETS Program Manager?
If so, please indicate best time and telephone number(s) to be reached between 8 am and 4:30 pm.
Best Times
Alicia Johnson
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: 1300 French Creek Drive (Deborah Hopp) Parcel ID: 1011723230004
_
City: Orono stem: __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 completed and signed by a Designated Certified Individual (DCI) of a licensed SSTS
Maintenance Business who personally conducts the necessary procedures to assess the compliance status of each sewage tank in
the system.
When this section of the form is signed by a qualified certified professional, it becomes necessary supporting documentation to an
Existing System Compliance Inspection Report: ComoIlan ce inspection form Existing system Lv6M_vOvist 4:=. This form can be
found on the IVIPCA website at h d/vuww oca state mn us/water/sets-and-mats-technical-and-cemgliance-criteria.
The lnformation and certified statement on this form is required when existing septic tank compliance status is determined by an
individual 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 form is valid for a period of
three years 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 Items B, C, and D; 7083.0730 Item C.
B( Certificate of sewage tank compliance
Affirm all three statements:
N The SSTS does not contain a seepage pit, cesspool,
drywell, leaching pit, or other pit.
it does not contain a sewage tank that was designed
to be watertight, but subsequently leaks below the
designed operating depth.
® It does not represent an imminent safety threat by
reason of unsecured, damaged, or weak
maintenance hole cover(s) or other unsafe condition.
❑ Notice of sewage tank non-compliance
Select all that apply:
❑ The SSTS has a seepage pit, 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 to public safety by reason of
unsecured, damaged, or weak maintenance hole
cover(s) or other unsafe condition.
Company information Designated Certified Individual (DCI) Information
Company name: Albirfs Septic Pumping, LLC Print name: Peter Peterson _ _ —
Business license number: 3346_.__. Certification number: 9227 _ .
I personally conducted the work described above as a Designated Certified Individual of a Minnesota4censed SSTS Maintenance
Business. I personally conducted t,73ry procedures to assess the compliance status of each sewage tank in this SSTS:
Designated Certified 08/15/2022
Individuars signature: Date (mmldd/yyyy): _ _.
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