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�� ,� Minnesota Pollution Compliance Inspection Form <br /> :x, <br /> � Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) <br /> St Paul,MN SS155-4194 Doc Type:Compliance and Enforcement <br /> InspeCtion results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <br /> requirements and attached forms—additional local requirements may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owner <br /> within 15 days <br /> System Status <br /> System status on date(mm/dd/yyyy): 2/22/2017 <br /> � Compliant—Certificate of Compiiance ❑ Noncompliant— Notice of Noncompliance <br /> (Valid for 3 years from report date, unless shorter 6me (See Upgrade Requirements on page 3.) <br /> frame outlined in Local Ordinance.) <br /> Reason(s)for noncompliance(check all applicable) <br /> ❑ Impact on Public Health(Compliance Component#1)—lmminent fhreat to public health and safety <br /> ❑Other Compliance Canditions(Compliance Component#3)—imminenf fhreat to pub(ic healfh and safety <br /> ❑Tank Integrity(Compliance Component#2)—Failing to profect groundwater <br /> ❑Other Compiiance Conditions(Compliance Component#3)—Failing to protect groundwater <br /> ❑Soil Separation (Compliance Component#4)—Failing to protect groundwafer <br /> ❑Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: <br /> Property address: 2555 Fox Street,Orono Reason for inspection: Sale <br /> Property owner John Grudnowski _ Owner's phone: 715-865-2243 <br /> or — <br /> Owner's representative: _ _ Representative phone: <br /> Local regulatory authority: City , Regulatory authority phone: <br /> Brief system description: 2-1000 Septic&1000 pump,split rockbed at grade <br /> Comments or recommendations: <br /> There is concern that when wetland and creek rise that water will flow into the covers of the septic tanks especially the pump tank. <br /> Snow melt water was close to running into pump tank. <br /> Recommend Raising Covers <br /> Certification <br /> !hereby certify that all the necessary infom►ation has been gafhered to determine the compliance sfafus of this system. No <br /> determinaSon of future system perfonnance has been nor can be msde due to unknown conditions during system constructron, <br /> possrble abuse of the sysfem,inadequate maintenance, or future water usage. <br /> Inspector name: Josh Swedl nd � Certification number: C1659 <br /> Business name: Swedlund tic S ce _ License number: 2502 <br /> _ _ <br /> Inspector signature: __ Phone number: 952-873-3292 <br /> Necessary or Local Required Attachments <br /> �Soil boring logs �System/As-built drawing �J Forms per focal ordinance <br /> ❑Other information(fist): <br /> www.pca.state.mn.us • 651-296•6300 . 800-657-3864 • T7Y 651-282-5332 or 800.657-3864 . Available in altemative formats <br /> wq•wwists4-3l • 3/16/12 <br /> Page 1 of 3 <br />