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07/01/2021 Septic Compliance Report
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07/01/2021 Septic Compliance Report
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Last modified
8/22/2023 4:52:22 PM
Creation date
7/9/2021 9:56:43 AM
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x Address Old
House Number
120
Street Name
Golden View
Street Type
Drive
Address
120 Golden View Drive
Document Type
Septic
PIN
3311823430024
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MINNESOTA POLLUTION CONTROL AGENCY Compliance inspectionreport r�art form <br />520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) <br />5t. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement <br />Instructions: Inspection results based on Minnesota Pollution Control Agency (MPGA) requirements and attached supporting <br />documentation — additional local requirements may also apply. Further information can be found here: <br />https://www.pca.state.mn.us/sites/default/files/wg-wwists4-31 a. df. <br />Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final <br />determination of compliance or noncompliance. <br />Property information Local tracking number: <br />Parcel ID# or Sec/Twp/Range: 3311823430024 Local regulatory authority: City of Orono <br />Property address: 120 Golden View Drive, Orono Hennepin County <br />Owner/representative: Devon Carlson _ Owner's phone: 952-_356-6240 <br />Brief system description: 2-1000 gallon septic tanks, 1-1000 gallon lift station and 500 Square feet Rock bed <br />System status <br />System status on date (mm/dd/yyyy): 0710//2021 <br />E Compliant — Certificate of compliance* <br />(Valid for 3 years from report date unless evidence of <br />an imminent threat to public health or safety requiring <br />removal and abatement under section 145A.04, <br />subdivision S is discovered or a shorter time frame exists <br />in Local Ordinance.) <br />*Note: Compliance indicates conformance with Minn. <br />R. 7080.1500 as of system status date above and <br />does not guarantee future performance. <br />❑ Noncompliant— Notice of noncompliance <br />An imminent threat to public health and safety (ITPHS) must be <br />upgraded, replaced, or its use discontinued within ten months of <br />receipt of this notice or within a shorter period if required by <br />local ordinance or under section 145A.04 subdivision S. <br />Systems failing to protect ground water most be upgraded, <br />replaced, or use discontinued within the time required by local <br />ordinance. <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 />The system was designed for 1.0 feet of sand there is 1.8 feet of sand. <br />The second tank is starting to corrode and will need to be replaced sometime in the future. See the tank report. <br />Certification <br />I hereby certify that all the necessary information has been gathered to determine 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 statements to be true and correct, to the best of my knowledge, and that this information <br />can be used for the purpose of processing this form. <br />Business name: Rusty Olson's Soil & Perc. Testing Certification number: C-1255 <br />Inspector signature: License number: 810 <br />his docu lectronically signed) Phone: 763-498-8779 <br />Necessary or locally required supporting documentation (must be attached) <br />® Soil observation logs <br />❑ Other information (list): <br />https://www.pca.state.mn,us <br />wq-wwists4-31b • I111121 <br />❑ Locally required forms <br />• 651-296-6300 500-657-3864 - <br />® Tank Integrity Assessment ❑ Operating Permit <br />Use your preferred relay service Available in alternative formats <br />Page 1 of 4 <br />
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