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09/10/2015 2 : 52P1�1 FAX �0001/0004 <br /> ��. <br /> :'�;•, � Minnesota Pollution ���������� Snspectian Form <br /> a�:.._<>.,� <br /> '� ''`'~�.�r Cantrol Agency <br /> ,;, :;:«...:_. <br /> ^ 520 Lafayette Road North Exi�ting �ubsur�ac� �ewage Treatment Syst�ms (SSTS) <br /> St.Paul,MfV 55155-4194 Doc Type:CompllallCA 2f)d E»foroement <br /> I For local tr�� a� <br /> lnspeCtloll t'esults based on Minnesota Pollution Control Agency(MPCA) �L� <br /> requirements and attach�d forms—additionallocal requirementS may a180�pply. <br /> Submif completed form 4o Local Unit of Gvvernmen#(LUG)and system owner ��P � � 20�5 <br /> withln 15 days _ _ .._._ <br /> `il� � �� <br /> System Status <br /> System status on date(mmlddlyyyy)� 9/90/2015 <br /> � Compliant-- Cerfificate af Compliance ❑ Noncompliar�t— Notice of Noncompliance <br /> (V�lid for 3 years from report dete, unless sho!tcr fime (See Upgrade Requir�ments an page 3.) <br /> fr�me outlrned in Loca!Ordi»ance.J <br /> Reason(s)for noneompliance (check a!I appllcab/e) <br /> ❑ Impact on Piibfic Wealth (Compllance Component#1)—Imminent fhreat to public health and safety <br /> ❑ Other Compliance Conditions(Compliance Gomponent#3)—lmminent fhreat to public healfh snd safety <br /> �Tank In#egrity(Complir�nce Component#2}—Failrng to protect groundwafer <br /> [] Other Compliance Conditions (Complia�lce Component#3)—Failing ta protect groundwater <br /> � Soil Separation(Compfiance Component#4)—Failing to protect groundwater <br /> ❑ Operating permiUmonitoring plan requirements(Compfiance Component#5)—Noncompliant <br /> Property Information Parcel iD#or Sec/Twp/R�nge <br /> Prope�ty address: 135 Crystal Creek Road, Orono __ _ Reasbn for inspectiort: Sale ____ <br /> Property owner; Lorraine Goodwald ____. Owner's phone: 952-249_1552_ __ <br /> or . <br /> Owners representative: _ _ Representative phone: <br /> Locaf regulatory authority; CitV of Orono Regulatory authority phone: <br /> Brief system description; 1250 1000 Septic E�1250 pump tank with a mound system _ _. <br /> Comments or recornmendations: <br /> Remove rubber coupling from inside pump tank-not meant for pressure applications&wil!come appart eventually <br /> Mark all 3 septic tanK manholes witlz something highly visible due to woods and tall weeds thEy are very difficuit to find and wi11 be <br /> almost impossible in heavy snow if ihere is a problem in the winter <br /> Certification <br /> 1 hereby certify that a!1 tho nec�ssary information has been gathered[o defermine the compliance status of this system_ No <br /> de(�rminatr'on of futu�system performance has been nor can be made due to unknoUrn condltions during system constructlon, <br /> possiblo abuso of the system, rnadequate mainfenance, or future water usage. <br /> Inspector name: Josh Swedlu d _ Certification number� C'l659 <br /> Business name: Swedlu tic . rvic __ License number: 2502 <br /> Inspector signature: __ _ Phone number; 952-673-3292 <br /> Necessary or L� a{ly Required Attachm�nts <br /> � Soil boring logs �1 5ystem/As-built drawing � Forms per local ordinance <br /> ❑ Other information(list): . <br /> www.pca.state.mn.us • 651•296�6300 • 800•657-3864 � TTY 651-282-5332 or 8Q0-657-3864 • Available in alternative formats <br /> wq-wwists4-3f • 3/I6/12 Page 1 of 3 <br /> ' <br />