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�� � <br /> � � � <br /> • �/� � ��� . . <br /> �� Minnesota Pollution � � Compljance inspect�on Forrr� <br /> ` �`�'���� �� Control Agency <br /> '���=`�`�' Existing Subsurface Sewage Treatment Systerr�s (SSTS) <br /> 520 Lafayette Road North <br /> St Paul,MN 55155-4194 Doc Type:Compliance and EnforGemenf <br /> In8peCtion�esults based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <br /> requirements and attached forms–additional local requi�ements may also apply. <br /> Submit complebed form to Locai Unit of Govemment(LUG)and system owner <br /> within 15 days <br /> System Status <br /> System status on date(mm/dd/yyyy): 6l26/2013 <br /> � Compliant—Certificate of Compiiance ❑ Noncompliant— Notice of Noncompliance <br /> (Valid for 3 years from report date, unless sho►ter time (See Upgrade Requi�ements on page 3.) <br /> ifarne outfined in Local O►rlinance.} <br /> Reason(s)for noncompliance(check all applicable) <br /> ❑ Impact on Public Health(Compliance Component#1)–lmminent threat to pu6lic health and safety <br /> ❑Other Compliance Conditions(Compliance Component#3)–Imminent th►eat fo public health and safety <br /> ❑Tank Integrity(Compliance Corrfponent#2)–Failing to protect groundwater <br /> ❑Other Compliance Conditions(Compliance Component#3)–Failing to protect groundwater <br /> ❑Soil Separation(Compliance Component#4)–Failingr to p►atecf groundwater <br /> ❑Operating permiUmonitoring plan requirements(Compliance Component#5)–Noncompliant <br /> Property Information Parcel ID#or SecJTwp/Range: <br /> Property address: 2680 Fox St Orono MN Reason for inspection: property transfer <br /> Property owner: Randy Bremher Owner's phone: <br /> or <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: Hennipen County C��O��� Regulatory authority phone: <br /> Brief system description: 2-1000 se tic tanks, 1-1000 um tank,mound heatment 10ft X66 ft rockbed <br /> Comments or recommendations: <br /> Certification <br /> 1 he%by cer6fy that a11 the necessary informafion has been gathened to detem►ine ihe comprance status of this system.Alo <br /> detennination of futu�e system perfo►mance has been nor can be made due to unknown ca►ditions during system consfruction, <br /> possiWe abuse of the sysfem,inadequate maintenance,or futu�water usage. <br /> Inspector name: Andrew Kleindl __ Certification number: 2926 <br /> Business name: Jim's Excavatin LLC License number: 2926 <br /> Inspector signature� Phone number. 952-442-9282 <br /> Necessary or Locally Required Attachments <br /> �Soil boring logs ❑System/As-built drawing ❑ Forms per local ordinance <br /> ❑Other irtfortttation(iistj: _ — <br /> www.pca.state.mn.us • 651-2%-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats <br /> wq-wwists4-31 • 3/16/12 Page 1 of 3 <br />