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08/06/2015 2 :44PM FAX Z0001/0004 <br /> Minnesota Pollution Compliance Inspection Form <br /> c% Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SETS) <br /> 5t.Paul,MN 55155-4194 Doc Type:Compliance and Enforcement <br /> Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracRE480JED <br /> requirements and attached forms—additional local requirements may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owner AUG 06 2015 <br /> within 15 days CITY OF; URONO <br /> System Status <br /> System status on date(mmiddlyyyy): 8/5/2015 _ <br /> Z Compliant— Certificate of Compliance F7 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 Local Ordinance.) <br /> Reason(s)for noncompliance(check all applicable) <br /> ❑ Impact on Public Health(Compliance Component#1)—imminent threat to public health and safety <br /> ❑ Other Compliance Conditions(Compliance Component 43)—Imminent threat to public health and safety <br /> ❑Tank Integrity(Compliance Component 92)—Failing to protect groundwater <br /> ❑ Other Compliance Conditions(Compliance Component#3)—Failing to protect groundwater <br /> ❑ Soil Separation(Compliance Component#4)--Failing to protect groundwater <br /> ❑Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: <br /> Property address: 2165 Watertown Road,Orono Reason for inspection: Sale <br /> Property owner_ Robert Kantor Owner's phone: 952-476-0875 <br /> or <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: City Regulatory authority phone: <br /> brief system description: 2- 1000 gallons septic tanks& 1000 gallon pump tank with a mound system <br /> Comments or recommendations: <br /> Certification <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 future water usage. <br /> Inspector name: Josh Swedlund Certification number: C1659 <br /> Business name: Swedlund Septic Service License number: 2502 <br /> Inspector signature: Phone number: 952-873-3292 <br /> Necessary or Locally 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-wwlsts4.31 - 3116112 Page I of 3 <br />