11-04-22 Septic Compliance Report

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MINNESOTA POLLUTION re Compliance inspection ort form CONTROL AGENCY p p p 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) 5t. Paul, MN 55155-4194 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 https://www.pca.state.mn.uslsites/default/files/wq-vvmsts4-31a.l)df. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: 3111823230007 Reason for Inspection Propery Transfer Local regulatory authority info: City Orono _ Property address: 480 Deborah Drive Owner/representative: Mary Raeth Owner's phone: 763-482-9584 Brief system description: Approximately 2 -1000 -gallon septic tanks, 1 -1000 -gallon lift station and 380 square feet of mound rock bed System status System status on date (mmldd/yyyy): 11/4/2022 ® Compliant — Certificate of compliance's (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 (ITPNS) most 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 permittmonitoring plan requirements (Compliance component #4) — Noncompliant - local ordinance applies Comments or recommendations There is 1.0 feet of sand under the rock bed. TBM: Top of the door threshold. ELV.-100.0 Certification 1 hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of 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, / 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: Rusty Olson Soil & percolation Testing Inspector signature: Joseph J. Olson (This document has been electronically signed) Certification number: C1255 License number: L810 Phone: 763-498-8779 Necessary or locally required supporting documentation (must be attached) ® Soil observation logs ® System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit ❑ Other information (list): https://www.pca.state.mri.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwist54-31b • 412812021 Page 1 of 4