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07/28/2015 9: 17AM FAX �0001/0004 <br /> � ' <br /> . <br /> � �t,.��°"��°� Compliance Inspectian Farm <br /> � �o <br /> �� <br /> ����� Existing SubsurfaCe Sewage Treatment $ystems (SSTS) <br /> S�.,R�ul�01�'1'�75�r4794F Doc Type.�Compliance end Enioraement <br /> Inspection resu{ts based on Minnesota Pollution Control Agency(MPGA) �or local tracking purposes: <br /> requirements and attached forms—additional local requirements may also apply. <br /> Submit completed#orm to Local Unit of Government(LUG)and system owner <br /> wifhin 15 days <br /> System Sfiatus <br /> System stetus on date(mmlddlyyyy): 7/27/2015 <br /> � Compllant—Certificate of Campliance ❑ Noncompliant— Notice of Noncompliance <br /> (Valid for 3 years frorn report date, un/ess shwter time (Se�Upgrade Requirementa on page 3.) <br /> frame outlfned in Loca!brdinance.} <br /> Reason(s)for noncompliance(check all applicable) <br /> r]Impact on Public Health(Compllance Componenf#i)—Immfnent threat to public hpalfh and safety <br /> ❑Other Compliance Condltions(Compliance Component#3)—lmminent threat to public health and sefety <br /> ❑Tank Integrity(Compliance Gattponenf#t2)—Failing to protectgroundwafer <br /> ❑Othe�Comp(iance Conditions(Complrance Component#3)—Failing fo pn�tect groundwater <br /> ❑Soil Separation(Compliance Component#4)—Failing to protecf gn�undweler <br /> ❑ Operating permlVmonitoring plan requirements(Compllance Component#5)—Noncom�lrant <br /> Property Information Parcel ID#or Sec/Twp/Range: _ <br /> Property address: 710 Big island,prono,MN 55331 Reason for inspectlon; Sale <br /> Properry owner; Gerald 5cane pwner's phone: 612-743-2723 <br /> or <br /> Owner's reprBsentative: _ _ _ Representative phone: <br /> LoCal regulatory autho�ity; Clty of Orono . _ Regulatory authority phone: _ _ <br /> grief system description: This is an elevated chamber system with 2-1000 gallon septic tanks and a 1000 galion pump tank. <br /> Comments or recommendations: <br /> 7he drainfield needs approximately 8"of bl�ck dirt covering the areas that have been eroded. <br /> Certification <br /> I hereby certify thet al!the necessary informatial has been gathered to determine tha compliance status of thrs system.No <br /> determfnatfon of future syst�m perfiarrnance has been nor can be made�iue to unknown eondifrons during system consiruction, <br /> possib/e�buse of Phe sys�`erm,.xnadet�ua7�!mma�hrtenance, or fulure waler usage. <br /> Inspectorname: JoshSwedtund , Certification number: C1659 <br /> Business name: Swedh3nd S t"rc� 'ae License number. 2502 <br /> _.... -- <br /> Inspactor signatu►e: _._._._ � Phone number: 952-873-3292 <br /> Necessary or Locally Required Attachments <br /> � So31 boring logs �System/As-builf drawing �Forms per lacal ordinanca <br /> ❑ Other information{list); _ _ _ <br /> www.pcastate.mn.us • 651-Z96-6300 • 840-657-3864 . M 651•z82-533z or B00-657-38b4 • Avaiiable 1n alternative formats <br /> wq-wwists4-31 • 3!16l 11 Paqe 1 of 3 <br />