Laserfiche WebLink
1 MINNESOTA POLLUTION Compliance in <br />CONTROL AGENCY p <br />520 Lafayette Road North Existing Subsurface <br />St. Paul, MN 55155-4194 <br />Instructions: Inspection results based on Minnesota Pollution Control Agency (MPCA) r( <br />documentation — additional local requirements may also apply. Further information can be <br />httos�//www oca state mn us/sites/default/files/wa-vvwists4-31a odf. <br />Inspector must submit completed form to Local Governmental Unit (LGU) and syste <br />determination of compliance or noncompliance. <br />r information Local trackin <br />Parcel ID# or Sec/Twp/Range: <br />Local regulatory authority: <br />Property address: 525 Leaf Street, Orono <br />Owner/representative: True Victory Christian Fellowship <br />Brief system description_1500/2 (house) 2 x 1000 (church) & 2000 cal shared <br />System status <br />System status on date (mm/dd/yyyy): 1/18/2022 <br />® Compliant —Certificate of compliance' <br />(Valid for 3 years from report date unless evidence of <br />an imminent threat to public health or safety requiring <br />removal and abatement under section 145A.04, <br />subdivision 8 is discovered or a shorter time frame exists <br />in Local Ordinance.) <br />*Note: Compliance indicates conformance with Minn. <br />R. 7080,1500 as of system status date above and <br />does not guarantee future performance. <br />!ction report form <br />reatment System (SSTS) <br />Doc Type: Compliance and Enforcement <br />and attached supporting <br />here: <br />within 15 days of final <br />Owner's phone: 406-585-7797 <br />❑ Noncompliant — Notic*of noncompliance <br />An imminent threat to IPuI health and safety (ITPHS) must be <br />upgraded, replaced, o it3 use discontinued within ten months of <br />receipt of this notice o ithin a shorter period if required by <br />local ordinance or unc er section 145A.04 subdivision 8. <br />Systems failing to prol ect ground water must be upgraded, <br />replaced, or use disco pti ued within the time required by local <br />ordinance. <br />Reason(s) for noncompliance (check all applicable) <br />❑ Impact on public health (Compliance component #1) — Imminent threat to public health <br />❑ Tank integrity (Compliance component #2) — Failing to protect groundwater <br />❑ Other Compliance Conditions (Compliance component #3) — Imminent threat to public <br />❑ Other Compliance Conditions (Compliance component #3) — Failing to protect groundv <br />❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) <br />❑ Soil separation (Compliance component #5) — Failing to protect groundwater <br />❑ Operating permittmonitoring plan requirements (Compliance component #4) — Noncom <br />Comments or recommendations <br />Certification <br />I hereby certify that all the necessary information has been gathered to determine the compile <br />determination of future system performance has been nor can be made due to unknown conc <br />abuse of the system, inadequate maintenance, or future water usage. <br />By typing my name below, I certify the above statements to be tr a and correct, to the best <br />can be used for the purpose fflocessi is f r <br />Business name: Sewer ices Certification r <br />Inspector License r <br />his doa7ment has been electronically signed) <br />Necessary or locally required supporting documentation (must t <br />® Soil observation logs <br />❑ Other information (list): <br />https://www.pca.state. mn. us <br />wq-ww1sts4-31b • 1/11/21 <br />® Locally required forms ® Tank Integrity <br />• 651-296-6300 <br />• 800-657-3864 Use your <br />safety <br />It and safety <br />ling to protect groundwater <br />t -local ordinance applies <br />status of this system. No <br />s during system construction, possible <br />knowledge, and that this information <br />C1659 <br />952-873-3292 <br />❑ Operating Permit <br />• Available in alternative formats <br />Page 1 of 4 <br />