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Mit MINNESOTA POLLUTION CONTROL AGENCY Compliance Inspection form Lafayette Road North St. Paul, MN 55155-4194 9 Existin Subsurface Se (Wage Treatment System (SSTS) St. Doc Type: Compliance and Enforcement Instructions: Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final determination of compliance or noncompliance. Instructions -for filling out this form are located on the Minnesota Pollution Control Agency (MPCA) website at hftps://www.pca.state.mn.usisites/default/files/wq-wwists4-31 a. pdf. Property Information Local tracking number: Parcel ID# or Secrrwp/Range: 32-118.23-31.0001 Reason for Inspection: Sale Local regulatory authority info: Orono Property address: 385 Stubbs Bay Rd N, Orono Mn 55356 Owner/representative: Bridget Taylor Owner's phone: 763-370-7546 Brief system description: System status 2015 3 Bedroom 10'x38' Mound, (2) 1000 gal, 1000 gal pump tank (Precast) System status on date (mm/dd/yyyy): 3/1/2022 ❑' Compliant— Certificate of compliance- (valid ompliance• (valid for 3 years from report date unless evidence of an imminent threat to public health or safety requiring removal and abatement under section 145A.04, subdivision 8 is discovered or a shorter time frame exists in Local Ordinance.) *Note: Compliance indicates conformance with Minn. R. 7080.1500 as of system status date above and does not guarantee future performance. ❑ Noncompliant —Notice of noncompliance Systems failing to protect ground water must be upgraded, replaced, or use discontinued within the time required by local ordinance. An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance or under section 145A.04 subdivision 8. Reason(s) for noncompliance (check all applicable) ❑ Impact on public health (Compliance component #1) — Imminent threat to public health and safety ❑ Tank integrity (Compliance component #2) — Failing to protect groundwater ❑ Other Compliance Conditions (Compliance component #3) — Imminent threat to public health and safety ❑ Other Compliance Conditions (Compliance component #3) — Failing to protect groundwater ❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) — Failing to protect groundwater ❑ Soil separation (Compliance component #5) — Failing to protect groundwater ❑ Operating permillmonitoring plan requirements (Compliance component #4) — Noncompliant - Inral nrdinann, nsov Comments or recommendations -- — Recommend mowing the above ground mound system and tank area once a year to keep brush and tree roots from getting into the rockbed or tank. Pump the septic tanks this summer (1.5" scum and 3" sludge) and every 2-3years. Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of the future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. 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 can be used for the Purpose of processing this form. Business name: Ingleside Engineering& Constuction, Inc. Certification number: 7878 Inspector signature: License number: 874 (This document has been electronicaV signed) Phone number: 763-479-1869 Necessary or Locally Required Attachments (must be attached) E Soil observation logs 0 System/as-built ❑ Locally required forms ❑ Tank Integrity Assessment Operating permit [] Other information (list): Homeowner testimony Property address: 385 Stubbs Bay Rd N, Orono Mn 55356 Business Name: Ingleside Engineering & Constuction, Inc. Date: 3/1/2022 (mm/dd/yyyy) wq-wwists4-310 • 7/12/21• www.pca.slate.mn.us - Available in alternative formats - 651-296-5300 • 800.657-3864 • TTY 651-282-5332 or 800-667-3864 Page 1 of4