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, � ����, Minnesata �ollution COCp �11C1Ce �IIS CCt10t1 FOr!'1'1 <br /> �w Control Agency � p <br /> � ��" � Exisfing Subsurface Sewage Treatment S stems SSTS <br /> 520 Lafayette Road North Y ( } <br /> St.Paul,MN 55155-4194 Doc Type:Compliance and Enforcement <br /> InspeCtion reSults based on Minnesota Pollution Control l�gency(MPCA) For local tracking purposes: <br /> requirements and attached forms–additional local requirements may also apply. <br /> Submit complebed form to Local Unit of Government(LUG)and system owner <br /> within 15 days <br /> System Status <br /> System status on date(mmldd/yyyy): 5/30/2017 <br /> � Compliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance <br /> {Valid for 3 years from report date, unless shorter fime (See Upgrade Requirements on page 3.) <br /> frame ouflined in Local Ordinance.) <br /> Reason(s)for noncompliance (check all applicab/e) <br /> ❑ Impact on Public Health (Compliance Component#1)–Imminent threat to public health and safety <br /> ❑ Other Compliance Conditions(Compliance Component#3)–Imminenf fhreat to public health and safety <br /> ❑Tank Integrity(Compliance Component#2)–Failing to protect groundwater <br /> ❑ Other Compliance Conditions(Complisnce Component#3)–Failing fo p�tect groundwater <br /> ❑ Soil Separation(Compliance Component#4)–Failing to protect groundwater <br /> ❑ Operating permiUmonitoring plan requirements(Compliance Component#5)–Noncomplianf <br /> Property Information Parcel ID#or Sec/l"wp/Range: <br /> Property address: 4440 Bayside Road, Orono Reason for inspection: Sale <br /> Property owner: David Montecalvo _ . Owner's phone: 952-472-0219 <br /> or - - — <br /> Owner's representative: Representative phone: <br /> _... ..— <br /> Local regulatory authority: City Regulatory authority phone: <br /> Brief system description: 2-1000 gal se tic tanks& 1000 gal pump tank with a mound system <br /> Comments or recommendations: � <br /> Certification <br /> I hereby certify that alI the necessary information has been gafhered to determine the compliance stafus of this system. No <br /> deterrnination of future system pertorrnance has been nor can be made due to unknown conditions during system consfruction, <br /> possible abuse of the system, inadequate maintenance, or future water usage. <br /> Inspector name: Josh Swedlund Certification number: C1659 <br /> Business name: Sewer S ' es License number: 2502 <br /> Inspector signature: Phone number: 952-873-3292 <br /> Necessary or Lo ally 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 • 3/16/12 „___ , _�, <br />