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Minnesota Pollution Compliance Inspection Form 4_ Control Agency 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 (MPGA) For local tracking purposes: requirements and attached forms — additional local requirements may also apply. Submit completed forth to Local Unit of Goverment (LUG) and system owner within 15 days _ System Status System status on date (mm/ddlyyyy) 8/5/2020 ® Compliant — Certificate of Compliance ❑ 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 ❑ 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 ❑ Soil Separation (Compliance Component #4) — Failing to protect groundwater ❑ Operating permit/monitoring plan requirements (Compliance Component #5) — Noncompliant Property Information Property address: 2850 Wear Circle L Property owner. Nicholas and Mariah or Owner's representative: Parcel ID# or Sec/Twp/Range: 33-118-23-34-0008 MN Reason for inspection: Tank Replacement Owner's phone: 612-437-5522 Representative phone: Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 2-1000 gallon septic tanks and a 1000 gallon pump tank. Effluent pumped to a 20 inch sand lift mound Brief system description: with a 10'x45' rockbed. Comments or recommendations: Certification I 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. Inspector name: Tristan Ende Certification number: C9206 Business name: Ende S c Servi _ License number: L2654 Inspector signature: Phone number: 763428-4489 Necessary or Locally 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 alterative formats wq-ww4sts4-31b • 614114 Page 1 of 3