Laserfiche WebLink
Minnesota Pollution Compliance Inspection Form <br /> Montes <br /> Agency <br /> 51ioLafayette Reed North Existing Subsurface Sewage Treatment Systems <br /> 5L Paul MN 35133419a (SSTS) <br /> rw n,....r.....ntano.....4/F.ahe..w..... <br /> v.....��......reel.S.w.rnrva...s... <br /> Instructions: inspection result based on Minnesota Polittwl Control Agency(MPCA1 • For{oral treddng purposes <br /> requirements and iltedied fomn-additional local requtenents nay also apply. <br /> Submit completed form to coal Unit of Government(LUG)and system owner <br /> Within 15 days <br /> System Status <br /> System status on date(rnmtddlyyyy): 812412015 _._ <br /> 0 Compliant-Certificate of Compliance 0 Noncompliant—Notice of Noncompliance <br /> (Vafd(or 3 years from/Waif delt unless shorter ins (Sas Upgrade Ragranrnentt on pogo 3) <br /> tarp;vi O i8D aiI t a'OtiJW j <br /> Reasons)for noncompliance(check all eeAlcabto) <br /> ❑lntpsc3 on Public Hall=(CaMpflance Component a#1)-bemineN*oat to public heelh and safety <br /> Cl Other Compliance Conditions(Compliance Carsponanl 53)-/mminenr cheat to pubic heath and safely► <br /> C1 rank Integrity(Compliance Corrrponent MI-FalatD to protect gratintliveter <br /> ©Other Compliance Conditions(Compliance Component 0)-Faring to protect oroundwahr <br /> u <br /> Soi&Maranon{Compliance Component 44)-Poing fv praiscripoundwatsr <br /> CI OeiaSrc pemaiUMara>earirap plan requirements f©ompiance Component#A-honcompernt <br /> Property information Parcel Ryall or SectrwprRange St111 _-- -.--- <br /> Properly address: 785 Ferridalee Mil�1-Omono.MN Reason br inspection. Tr rw <br /> rroper '8iai►ttif: -moo _ o n— a <br /> or <br /> O nms rs neprountstive - Rn praaaaa a phone. <br /> Local regulatory authority: _MY 4 ._.. wry authority phone: 9R-241Z-41)00 <br /> $1000 gallon septic tanke.1-1000 gallon lift station and 500 square feat of mound rorkbed.per city <br /> Brief system description: records., .-- <br /> Comments or reconantendaalons• <br /> The dead path, (grecs*is caused by lawn service.As per owner <br /> Certification <br /> I hereby cerlWWy that all the necessary information hrsbee+gathered to datarmme the ocerealence status of this system,No <br /> r arinrrpee4n Mtn, MO. de <br /> a ferri, formerigi had been oar can be r?f! °tr.oondltimns thee, system cnneteRAtt <br /> possible abuse of the system.Inovadequate msUuenancei or1tdrire water usege. <br /> inspector name: Josech Olson_ .- .— Certification number. tali _.--- <br /> Business name. Rustirpintire Sot aPere _ t nun ber: 810 --- <br /> inspector signatu -� �:::w-=-.,�_� - Phone number: _7e+eas-a ry RFCJVED <br /> Necessary or Locally Required Attachments SEP 19 2017 <br /> ®sae botmg toga ®System/As-built drawing p Borns per local ordinance <br /> ©Other unfonra pion(list): •_— —_ <br /> www.poinate.msa.as • 651.295.6300 • W0.657.38&4 • 77Y 651.282.5331 or�e0o•657-3164 . rowing/in sue/wive rennets <br /> wq�+rwrsLKJt • t/1.1!12 # 3976 <br /> sr,e.Z.d L6ZLZLB£91 09Ucluelndf j0W!3 (189:40S LZ <br />