1905 Heritage Drive - Septic Compliance

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MINNESOTA POLLUTION CONTROL AGENCY SSTS Abandonment Reporting ortin form Subsurface Sewage Treatment Systems (SSTS) Doc TypeData Collection Instructions: This form is offered to meet the abandonment requirements of Minn. R. 7080.2500 and Disclosure Requirements of Minn. Start. § 115.55, subd. 6. Future water supply well placement can also be affected by an abandoned Subsurface Sewage Treatment System (SSTS). The use of this form is not mandatory; however, the information on this form must be submitted to the local government unit (LGU) within 90 days after the abandonment. Please do not send this completed form to the MPCA. This form may be completed by a certified SSTS practitioner or by an individual who has direct knowledge of how the system was abandoned. Property Information Local tracking number: Date of abandonment: 8/8/2026 Reason for abandonment: Property owner name(s): Kyle Barker Property owners address: 1905 Heritage Drive City: Orono Site address (rf different): City: Compliance Information 1. All solids and liquids removed from all tanks? ® Yes ❑ No Disposal Site: State: Minnesota Zip: 55391 E 2. All electrical devices and devices containing mercury removed? ® Yes ❑ No Disposal Site: Veit Environmental - Metro non hazardous tanks drained previously 3. All underground sewage tanks crushed and filled with soil or rock material? ❑ Yes ® No or Removed and disposed off site? ® Yes ❑ No Disposal Site: Veit Environmental - Metro non hazardous tanks drained previously 4. Contaminated material' removed and disposed off site? ❑ Yes ® No Disposal Site: 5. All underground cavities" crushed and filled with soil or rock material? ® Yes ❑ No or. Removed and disposed off site? ❑ Yes ❑ No Disposal Site: 6. Future discharge to system permanently denied? ® Yes ❑ No Method(s) used: Disconnected and Capped Zip: *Contaminated materials = Distribution media, soil or said within three feet of the system bottom, distribution pipes, gootexhle fabrwAosin papenstraw, tanks, contaminated soil around leaking tanks, any soil that received sewage from a surface failure (7080.2500, subp.3). "Underground cavities = Cesspools, leaching pits, drywells, seepage pits. vault privies, pit privies, pump chambers (7080.2500, strop. 1). Does not include chamber media, drop boxes, or distribution boxes. https.//www.pq.sMe.mn.us 6S1-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-masts4-03 • 9126125 Page 1 of 2