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Minnesota Pollution Compliance Inspection Form <br />Control Agency <br />520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) <br />5t. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement <br />Inspection results based on Minnesota Pollution Control Agency (MPGA) For local tracking purposes: <br />requirements and attached forms — additional local requirements may also apply. <br />Submit completed form to Local Unit of Government (LUG) and system owner <br />within 15 days <br />System Status <br />System status on date (mmidd/yyyy): 2/20/2020 <br />® Compliant — Certificate of Compliance <br />(Valid for 3 years from report date, unless shorter time <br />frame outlined in Local Ordinance.) <br />❑ Noncompliant — Notice of Noncompliance <br />(See Upgrade Requirements on page 3.) <br />Reason(s) for noncompliance (check all applicable) <br />❑ Impact on Public Health (Compliance Component #1) — Imminent threat to public health and safety <br />❑ Other Compliance Conditions (Compliance Component #3) — Imminent threat to public health and safety <br />❑ Tank Integrity (Compliance Component #2) — Failing to protect groundwater <br />❑ Other Compliance Conditions (Compliance Component #3) — Failing to protect groundwater <br />❑ Soil Separation (Compliance Component #4) — Failing to protect groundwater <br />❑ Operating permittmonitoring plan requirements (Compliance Component #5) — Noncompliant <br />Property Information Parcel ID# or Sec/Twp/Range: 1011723320010 <br />Property address: 1370 French Creek Drive Orono, MN 55391 Reason for inspection: Property Transfer _ <br />Property owner. Kevin and Michelle Gwash Owner's phone: 952-217-5671 <br />or <br />Owner's representative: Representative phone: <br />Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 <br />Brief system description: 2-1000 gallon septic tanks and a 1000 gallon pump tank to an elevated trench system. <br />Comments or recommendations: <br />All tanks have manhole covers to grade. <br />Certification <br />I hereby certify 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, <br />possible abuse of the system, inadequate maintenance, or future water usage. <br />Inspector name: Tristan Ende Certification number: C9206 <br />Business name: Ende Septic Service <br />Inspector signature: <br />Necessary or Locally Required Attachments <br />® Soil boring logs ® System/As-built drawing <br />❑ Other information (list): <br />www.pca.state.mn.us 651-296-6300 800-657-3864 <br />wq-wtyists4-31b • 6/4/14 + ` <br />License number: L2654 <br />Phone number: 763-428-4489 <br />❑ Forms per local ordinance <br />• TTY 651-282-5332 or 800-657-3864 Available in alternative formats <br />Page 1 of 3 <br />