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Minnesota Pollution Compliance inspection F�rm <br /> Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) <br /> St.P�ui,MN SSi55�747 lnstructions on page 7 <br /> Parcel number. z�-iia-z3-aa-000� <br /> System status: ❑Compliant �Noncompiiant <br /> (based on all compliance requirements) <br /> Summary Form <br /> Property information <br /> Property owner name(s): RICHARD W.PERKINS <br /> Property address: 1699 NORTH FARM RD-ORONO <br /> Property owne�s address(if differe�t): <br /> County: HENNEPIN Prope�ty ow�er phone: _ Permitting authority: ORONO <br /> Date system constructed� 1980? Reason for inspection; City update progtam <br /> System Description <br /> Brief system description: Septic tank(s)and drainfieid <br /> Local permit number: None Number of bedrooms: 3 Design flow rate: 450 <br /> Is the system: <br /> i�Shorela�d area? �Yes ❑No fn Weilhead Protection Area? ❑Yes �No <br /> An U.S.Environmental Protection System serving a Minnesota Department <br /> Agency(EPA)Class V Injection Well?�Yes �No of Heath(MDH)licensed facility? ❑Yes �No <br /> CO�T1P�1dIlC@ $tdtUS(Based on state requiremen!s—additional local requirements may also apply.) <br /> Based on the information gathered and reported on attached forms,the compliance status of this system is(check one): <br /> ❑Certificate of Compliance—vafid until(3 years from date of repo�t): <br /> �Notice of Noncompliance-For Noncompliant systems: <br /> The reason for noncompliance is: Mottled soils at 20 inches <br /> This noncompliant system is classified as(check one below): <br /> ❑fmminent threat to public health&safety �Failing to protect ground water ❑Not in compliance with operafi�g permit <br /> C@t'tlflGdtlO(1(Completed form must be submitted to the local unit of government within 15 days.) <br /> I hereby certify that all the necessary information has been gathered to determine the compliance status of this system.No <br /> determination of future system performance has been nor can be made due to unknown conditions during system construction, <br /> possible abuse of the system,inadequate maintenance,or fufure water usage. <br /> Name: Mark J Hayes Certification number: R5013 <br /> Business license name and number: Minnesota Geotechnical Services,LLC MPCA#L3203 or <br /> Name of tocal unit of government: Wright County <br /> Signature: M�J ��� Date: 7f12/9 <br /> Required Attachments tnspector Complete:This inspection Report is 6 pages long. <br /> Check compliance forms attdched: ❑Hydraulic Performance ❑Tank Integrity �Soil Separa6on �Operating Permit Form(if <br /> applica6le) �System drawing/As-built drawing ❑An assessment of any local requirements that are different from what is required on this <br /> form �Soil Boring Logs ❑Abandonment form(if appropriate) ❑Other information(list): <br /> UpfjfHdE REquiY2t11En[S(derived fi'OIl7 Minn.Sfaf.§115.55)An imminentthreal to pubfic health end safaty(lTPHSJ must bd upgraded,replaced,or <br /> its use disconfinued within ten months of receipt o!this rrotice or wilhin a sAo�ter peiiod if iequired 6y bca/oid'manc�.Ilthe system is Fading to protecf g,aund <br /> water,the system must be upgraded.�eplaced,w ds use dlscontlnued within the fime required by bcal ordinance.d an exis6ng system is not failing as defined in <br /> lavi,and has at leas!rivo fee[of design soi7 separation,then ffie system need nof be upgraded,repa"red,replaced,or its use disconfinued,notrrithsfanding any <br /> (ocal urtfimnce that is moie s6ict.This piovisinn duc�nbf app/y(o systerns in si,v�e/artd areas,WeNhead Proter.tion Are�s,oi t6ose used in r.onneclinn wifh fiiad, <br /> beverage,and lodging estab/isnments as de(ned irt law. <br /> wq-wwists4-31 Compliance lnspection Form for Existing SSTS <br /> 4/4/08 <br />