Community Assessment Report - Onsite Sewage Treatment ...

Compliance Inspection FormExisting Subsurface Sewage Treatment Systems(SSTS)Doc Type: Compliance and EnforcementInstructions: Inspection results based on Minnesota Pollution Control Agency (MPCA)requirements and attached forms – additional local requirements may also apply.Submit completed form to Local Unit of Government (LUG) and system ownerwithin 15 daysFor local tracking purposes:2012-697System StatusSystem status on date (mm/dd/yyyy): 5/7/2012Compliant – Certificate of Compliance(Valid for 3 years from report date, unless shorter timeframe outlined in Local Ordinance.)Noncompliant – Notice of Noncompliance(See Upgrade Requirements on page 3)Reason(s) for noncompliance (check all applicable)Impact on Public Health (Compliance Component #1) – Imminent threat to public health and safetyOther Compliance Conditions (Compliance Component #3) – Imminent threat to public health and safetyTank Integrity (Compliance Component #2) – Failing to protect groundwaterOther Compliance Conditions (Compliance Component #3) – Failing to protect groundwaterSoil Separation (Compliance Component #4) – Failing to protect groundwaterOperating permit/monitoring plan requirements (Compliance Component #5) – NoncompliantProperty Information Parcel ID# or Sec/Twp/Range: See CommentsProperty address: Cambridge Dr, Harris MN Reason for inspection: upgrade septic systemProperty owner: Rolling Shores Homeowners Assoc. Owner’s phone:orOwner’s representative:Representative phone:Local regulatory authority: Chisago County Regulatory authority phone: 651-213-8373Brief system description:Comments or recommendations:This is a community system with each site having there own septic tanks. A compliance inspections was performed in 2005 twhichshows the septic system was an imminent health threat and does not meet proper seperation for lake shore property. The parcelsin Rolling shores is as follows: 03.01358.01, .02, .03, .04, .05, .06, .07, .08, .10, .11, .12, .13, .14, .15, .16, .17 & .18. The tankintegrity was checked at this inspection.CertificationI hereby certify that all the necessary information has been gathered to determine the compliance status of this system. Nodetermination 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.Inspector name: Kellie Strobel Certification number: 6970Business name: Chisago County License number:Inspector signature: Phone number: 651-213-8373Necessary or Locally Required AttachmentsSoil boring logs System/As-built drawing Forms per local ordinanceOther information (list):www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formatswq-wwists4-31 • 1/24/12 Page 1 of 3