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. <br /> �; :�: , : Ntinnesota Pollution Compliance Inspection For�n <br /> ���r'�'�` Control ' <br /> Agency <br /> �� Existing Subsurface Sewage Treatment Syste�ns (SSTS) <br /> 520 Lafayette Road North a ti;. : <br /> 5�Paul,MN 55155-4194 ������"� poc Type:Complfanoe and E�►forae+nent <br /> � � _ <br /> Inspection results besed orr Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <br /> requmemerns and att�ed fomu-addieona��req�,��me�s r►ray a�so a�y. RECENED <br /> Submlt�form to Locaf Unit of Govemmerrt(LUG)and sysbem owner �Q� O � 2�1�J <br /> within 15 <br /> System Status C�TfY O�4RQN0 <br /> Sysbem statius on dabe(mrNdd/yyyy): 11A02�2015 <br /> ❑ Compliant—Certificafie of Compliance � Noncompliant— Notice of Noncompliance <br /> (Valid fior 3 years fir�m report date, uMess shorter time (See Upgrede Requi�menGs on page 3.) <br /> fiame outlined in Loca!O►dinance.) <br /> Reason(s)for noncompliance(check a/l appJicab/e) <br /> ❑ Impad on Public Health(Cary�liance Componerrt#k1)—Immir►ent threat to public healft►and safety <br /> ❑Other Compliance Conditions(Compliance Componer►t#3)—Immfnent threat to publlc health anct safety <br /> ❑Tank Integrity(Comphance Componer►t#2)—Failir►g to protect g►oundwater <br /> ❑Other Compliance Conditions(Compliance Componer►t�3)—Fai6ng to proted groundwater <br /> �Soil Separation(Cornplianoe Cornponent#4)—Fai►irtg to piofect giaw►dwater <br /> ❑Opera6ng pertnit/monitoring plan requiremerrts(Compliance Componenf#t5)—Nonoomptiant <br /> Property Information Parcel ID#or SecJTwpJRange: 36-1182�11-0028 <br /> Property addr+ess: 755 Femdal Rd.N Orona,Mn Reasan for inspection: Property Transfer <br /> Property owner. Bank of America Owner's phone: <br /> or <br /> Owners represerrtaWe: Taryn Kelzer Represerrtative phone: <br /> Local regulabory auftarity: City of Orono Regulatory authority ptione: 952-249-4600 <br /> Brief system description: 2-1000 gallons tanks to a gravity fed drainfield.Approx 600 gpd system <br /> Comme�s or recommendatlons: <br /> Certification <br /> 1 he�by certify that all the necessary info►►nation has been gathe►ed to dete►mine the oompliance status of this system.No <br /> dete►minaSon of future system perfiormanoe has been nor can be made due to unlv►own condifions during system ovnstn�cbion, <br /> possib/e abuse of fhe system,inadequate maintertance, or futw+e water usage- <br /> Inspector name: Tristan Ende Certification number: C9206 <br /> Business name: Ende � Servi Lic�nse number. L2654 <br /> Inspedor signatu : Phone number. 763-428-4�489 <br /> Necessary or Locatly Required Attachments <br /> ❑Soil boring logs ❑System/As-built drawing ❑Forms per local ordinance <br /> ❑Other information(list): <br /> www.pca.staGe.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-Z82-5332 or 800-657-3864 • Available in altemative formats <br /> W„_,.,,.,,r�r�a.���, . �ieife Aoge 1 of 3 <br />