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MINNESOTA POLLUTION <br />1 CONTROL AGENCY p inspection re Compliance ins ort form <br />p <br />520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) <br />St. Paul, MN 55155-4194 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 />https://www.pca.state.mn us/sites/defaulttfiles/wc-wwists4-31a odf. <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: Local regulatory authority: City of Orono <br />Property address: 300 Stubbs Bay Road Orono <br />Owner/representative: Jonah Burckhardt Owner's phone: 612-910-3877 <br />Brief system description: 2 - 1300 gal septic & 1300 gal pump tank effluent fitter, split rock bed mound syste <br />System status <br />System status on date (mm/dd/yyyy): 9/22/2021 <br />® 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 8 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 8. <br />Systems failing to protect ground water must 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 permittmonitoring plan requirements (Compliance component #4) — Noncompliant -local ordinance applies <br />Comments or recommendations <br />Owner has been backing a trailer across the end of the 2nd rock bed driving on the end slope -this needs to be stopped it is <br />causing compaction and also may cause the rockbed to leak out the end <br />Certification <br />i nereby cerury 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 b true and correct, to the best of my knowledge, and that this information <br />can be used for the purposeIf p ocess�tag�this fo . <br />Business name: Sewer ce c Certification number: C1659 <br />Inspector signature: License number: 2502 <br />is document has been electronically signed) Phone: 952-873-3292 <br />Necessary or locally required supporting documentation (must be attached) <br />® Soil observation logs ® Locally required forms ® Tank Integrity Assessment <br />9 y [I Operating Permit <br />❑ Other information (list): <br />nttps://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-ww1sts4-31b • 1/11/11 <br />Page 1 of 4 <br />