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Minnesota Pollution Compliance Inspection Form Control Agency P 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155-4194 Doc Type:Compliance and Enforcement Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: requirements and attached forms—additional local requirements may also apply. Submit completed form to Local Unit of Government(LUG)and system owner within 15 days System Status System status on date(mm/dd/yyyy): 1/22/2015 ® Compliant— Certificate of Compliance n Noncompliant — Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) frame outlined in Local Ordinance.) Reason(s)for noncompliance (check all applicable) ❑Impact on Public Health (Compliance Component#1)—Imminent threat to public health and safety El Other Compliance Conditions(Compliance Component#3)—Imminent threat to public health and safety ❑Tank Integrity(Compliance Component#2)—Failing to protect groundwater ❑ Other Compliance Conditions(Compliance Component#3)—Failing to protect groundwater El Soil Separation (Compliance Component#4)—Failing to protect groundwater 0 Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant Property Information Parcel ID#or Sec/Twp/Range: Property address: 4765 Watertown Road-Orono Reason for inspection: Sale Property owner: Michael Schultz Owner's phone: 612-483-6970 or Owner's representative: _ Representative phone: Local regulatory authority: City of Orono Regulatory authority phone: Brief system description: _2- 1000 gal septic tanks, 1000 gal pump tank&mound system _ Comments or recommendations: The discharge line for the sump pump is currently dumping out and flowing across the manholes of the septic tanks and water is definitely entering the tanks. Extend the sump pump lines downhill of the tanks Certification !hereby certify that alt 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. Inspector name: Josh Swedlund Certification number: C1659 Business name: Swedlund,;,. is et - _ License number: 2502 Inspector signature: //1116 f Phone number: 952-873-3292 Necessary or Lo .lly Required Attachments ®Soil boring logs ® System/As-built drawing ® Forms per local ordinance ❑Other information(list): www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 3116/12 Page 1 of 3