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, �;��So�a �� Cornpliance Inspection Forr� '��.�_- Car�trol Age�cy �zc�t�atayette�oad�vorth ��isfing �ubsurface Sewage °Treatment Systeores St.Pau1,MN 55155-4194 d��T�1 Doc Type:Compliance and Enforcement Instructions: Inspection results based on Minnesota Poilution Control Agency(MPCA) For local tracking purposes: requirements and attached forms-additional local requirements may also apply. RE(;E�VE� 5ubmit completed form to Local Unit of Government(LUG)and system owner NOV 1 � 2014 within 15 days _ CITY OF ORONO System Status System tafus on date(mm/dd/yyyy): Corn�liant— Cer�ificate of Gornplo�nce ❑ NOIICUI'i'1B10ia01$- IVO$6CL Of PdOi1C06D1pIl�I�C� (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3) frame outlined in Local Ordrnance.) Reason(s)for noncompliance (check all applicable) ❑ Impact on Public Health (Compliance Component #9J-Imminent threat to public health and safety ❑Other Compliance Conditions(Compliance Component#3)-Imminent threat to public health and safefy ❑Tank Integrity(Compliance Component #2)-Failing to protect groundwater �-, „ ,• „ ,•.. _ ,• ,-. __ ��, � �,,,. a,.,,.+.,. U v��idt i�vin�uaii�e ...uiii:uiuii�j��ii7j)nailCE vGii7j�v�;C;n.��—�rai�li7y iG j�iGi��,t y�"Cu.�.,�.,.w� ❑ Soil Separation(Compliance Component #4)-Failing to protect groundwater U vpeidiir�y pe��riumonitoring pian requirernents(Compliance Go�r,po�iC�iP �:,)-ivoncompliant Proper�y Inforrr�ation � Parcel ID#or Sec/Twp/Range: Pro ert address: � p y �g� �'/L.�,�� ,�cc�e� c,.�, _ Reason for inspection: Property owner. _ Owner's phone: _ or Owner's representative: Representative phone: Local regulatory authority: C� �v � Q�D�D Regulatory authority phone: Brief system description: �p�s rJe.c,a e�.�1� �_�_ c�+- � Comments or recommendations:�_�A,�s/� � ,� T�� e�..o� �•�- � �/ -�-� �--.�_�� Y+-q.,� ._.+�'. �c.S-a"�, ��/' /9� ��/ Certification 1 hereby certify thaf all the necessary information has been gathered to determrne the compliance status of this system. No determination of future system perfomrance has been nor can be made due fo unknown condrtions during system construction, possible abuse of the sysfem, inadequate maintenance, or future water usage. Inspector name: „�o12��J � ��v�:� Certification number. �,�,� Business name: M L �o Cv cS �-3 ca�=�o.�, S�.c�, ��- License number: p2�' Inspector signatu : Phone number: 7G,3- �7�!��o IVecessary or Locally ftequired Attachments ❑ Soil boring logs ❑System/As-built drawing ❑ Forms per local ordinance ❑ Other information (list): __