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-,,-:, � <br /> _ l._ t; _ '�t`�1�r '1 t',_ �� �� F'�;�aE Y';. ;�;� <br /> �15; i; . .'rt . . , �. ,` <br /> • X . �r <br /> . .1f � f� <br /> ;.k� Minnesota Pollution � Compliance lnspection Form <br /> ��+.._ - Contro) Agency <br /> '�� Exi�ting Subsurface Sewaye Treatment Systems (SSTS) <br /> 5!U lafayctt^.Road NorCh <br /> St.�av�,MN:5t=5-at9�1 D�c Type:�ompfianrc pnc+Enforc::m.:nf <br /> ]n3pection results ba�ed on Minn�sota Pollutiur�Con!ro!llyenr_V(MI'CA} � F�r local tracking purposes ', <br /> reqGirernents and attached�orms-additional loc.�l requirement.rnay also apply. � <br /> Subrnit compteted form to Local UNt of Govemment{I_i1G)and syst�m owner � <br /> withi� 15 d�y, <br /> $ySCC'fll SCdLUS <br /> 5ystpm status on date (mmldC/yyyy): _ 5/1 7�7.013 <br /> � Gompliant— Certificate of Compliance ' � Noncompliant — Notice of Noncompliance <br /> (Valid for 3 years from repat dafe, unless churtr;r rrrrn� ('See �lpqrade ReQurraments en paqs 3.I <br /> /rnme outlmed in l ncal O�zli,�arrce.) <br /> Reason�s) for nnncompliance (check all applicable) <br /> ] imnaci on Uublic Health (Cnn1p!ianr�romponen;#1)-lmmrnent threat fo puAlir,health and safsty <br /> [� Other Complianc�Ccnditions(Com,oliancc Compcnent!t3)- lrnminenf�hreat to putrlic haalth and safPty <br /> r] I ank Integrity (Compnanr,e Gompnnent i�2)-FarGr�q t��protecl qlr�u/ldv,'9(�r <br /> � Other C�mpliante Conditions('Con�pliance C.nrn�nnent#31-Failrny to proteCf Or'otmdwater <br /> �) Svil Separetio� (Currrplr'once Cnm))r�nenf�i�}•-F,3iknu Co pmle�ct qrourtdav8le� <br /> ❑ Operatinq permidmonitorinp pl�n repuirernenls (Compliance Componer��5)-rVoncomp/ian� <br /> Property Information f'�rCel IC'�or:;gC/TwpfRang�: <br /> Property eddregs: 1510 Ureen Tre� Road _ _ __ _ � �2eason for inspection Sale` _ __� <br /> i'roperiy owner NanCv Danko _ _ Uwne�5 phone 952-449-0020 <br /> c�r <br /> _- ---------- _._. ...___.------ —� -- ---------- <br /> Uwner's;epresentativ�: Fiepreser�tative phone� <br /> Loc�t regulatory authority: C�ty _ _ _ Requlatory authority phone: <br /> Brief systern descriptiun: <br /> ._ _ _ <br /> _. . _ ... ---- . —-... ------- — -- <br /> Comments or recomme�dations: <br /> Certifrcation <br /> !trr•rQby c�riify riiat al!the necessa�y ir�fr»mati%��r ii:�s Ueer1 gatlfered io c�etemune tl���,umplrance status of lhrs sysfem. Na <br /> dete�mina fion of futurc;ysfem peAomaance has hPen nnr cnn be m�de rl+�e!o unknnwn r,ondifions duriny syslerrt cons/ructrvrr. <br /> ooss�Dle aGuso of th�sys(em, rnadequa�t�mai��fonancr, or futurr, wnter ucp_qe. <br /> InspArtor n:�me� Josh Swedlund C+�rtifiration niimber C1fi59 <br /> - -- -- --� -- <br /> L�ia,m�ss name: Swedlund S�pTIC SnfVIC� License number� Z502 <br /> 'nspector signature: Fnone numbPr• 952-873-3292 <br /> Necessary or Locally Required AttachR�e�t$ <br /> � Snil b�riny logs � Systr_rn//1� builr.dr�winc7 [-J Formc�ar local orainance <br /> (-} C)ther inforrnation (list)� <br /> _ ------- -----—--- - --- ._._..---....-----_..... ____. . ------_ _ _----- - <br /> wv�v.p�as�are.mn.us � G5�-79h-Gz00 • Bnn-ti5I•iES� • 1"i'Y G51-ZpZ�5332 or 800•G57•36k� �vailable in alternar,iv�for^1ar,s <br /> . , <br /> 1YQ-Y.^NISI$�S-:I • 3!1G/92 ��...� ,. <br />