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. � <br /> �`� �,� �innesota Pollution Compliance In�pection Form <br /> ��� Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) <br /> St.Paul,Mtd 55155-4194 Doc Type:Compliance and Enforcement <br /> InspeCtii�n results based on Minnesota Poliution Control Agency(MPCA} For local tracking purposes: <br /> requirements and attached forms—additional locaf requirements may also apply. <br /> Submit completed form to Locai Unit of Government(LUG)and system owner <br /> within 15 days <br /> System Status <br /> System status on date(mm/ddlyyyy); 4/17/2017 <br /> � Coimpliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance <br /> (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) <br /> frame outlined in Loca/Ordinance,j <br /> Reason(s)for noncompliance{check a!I applicable) <br /> [] Impact on Public Health (Compliance Component#1)—Imminent threat to pubfic health and safety <br /> ❑ Other Compliance Conditions(Compliance Component#3)—Imminent th►�saf to public health and safety <br /> ❑Tank Integrity(Compliance Component#2)—Failing to protect groundwater <br /> ❑ Other Compliance Conditions(Compliance Component#3)—Failing to profect groundwater <br /> ❑Soil Separation (Compliance Component#4)—Failing to profect groundwater <br /> ❑Operating permiUmonitoring plan requirements(Compliance Component#5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: <br /> Property address: 465 Hunter Pass, Orono Reason for inspection: Sale <br /> Property owner: Jennifer Foster Owner's phone: 952-334-2757 <br /> or — <br /> Owner's representative: _ _ Representative phone: <br /> Local regulatory authority: City _ _� Regulatory authority phone: <br /> Brief system description: 1300&1000 Septic with a 1300 gal pump tank 5 bdrm mound system <br /> Comments or recommendations: <br /> Electric cords for pump and floats is not in electrical conduit,they are just burisd in dirt. Top section of riser should be replaced with <br /> plastic and a 2.5"electrical conduit installed <br /> Certification <br /> I hereby certify that aH fhe necessary information has been gathered to determine the compliance status of this system. No <br /> determination of futu�system performance has been nor can be made due to unknown condifions during system construcfion, <br /> possib/e abuse of the system, inadequate maintenance, or future water usage. <br /> Inspector name: Josh Swedlund Certification number: C1659 <br /> Business name: Sewer S ' es I c� ___ License number: 2502 � <br /> Inspector signature: _ Phone number: 952-873-3292 <br /> Necessary or � cally Required Attachments <br /> �Soil boring logs � System/As-built drawing � Forms per local ordinance <br /> ❑Other information (list): <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651•282-5332 or 800-657•3864 • Available in alternative formats <br /> wq-wwists4-.31 . 3/f 6/12 _ <br />