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��n�� . Minnesota Pollution C0171 liance Ins ection Form <br /> � Control Agency p p <br /> �°�- t Existing Subsurfaae Sewage Treatment Systems (SSTS} <br /> 520 Lafayette Raad North <br /> St.Paul,MN 55i55-4194 Doc Type:Compliance and Enforcement <br /> In8pe�tion results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <br /> requirejnents and attached forms—additional local requirements may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owner <br /> within I15 days <br /> System Status <br /> S�ystem status on date(mm/dd/yyyy): 5/9/2017 <br /> ❑ ($ompliant— Certificate of Compliance � Noncompliant— Notic� of Noncompliance <br /> (Valid for 3 years from repo►t date, unless shorter time (See Upgrade Requirements on page 3.) <br /> fi�eme ouNined in Local Ordinance.) <br /> I�eason(s)for noncompliance (check al!applicab/e) <br /> i� ❑ Impact on Public Health (Compliance Component#1)—lmminent threat to public health and safety <br /> I ❑Other Compliance Conditions(Compliance Component#3)—fmminent threaf fo public health and safety <br /> ', �Tank Integrity(Compliance Component#2)—Failing to protect groundwater <br /> ❑ Other Compliance Conditions(Compliance Component#3)—Failing to protect groundwater <br /> ', � Soil Separation(Compliance Component#4)—Failing to protecf groundwater <br /> ', ❑ Operating permit/monitoring plan requirements(Compllance Componenf#5)—Noncompliant <br /> Property Information Parcel ID#or SeclTwp/Range: ____ <br /> Property address: 525 Ferndale Road N, Orono Reason for inspection: Sale <br /> Property owner: James Ogland Owner's phone: 612-986-4541 <br /> or <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: Ciry of Orono _ ____ Regulatory authority phone: <br /> Brief system description: 2 -block ta�ks and a gravity�ock trench <br /> Comm�ents or recommendations: <br /> System had been inspected by city and labeled as non-compliant on 7/26/2001 and was supossed to be replaced by 12/31/2010 <br /> Certi�'ication <br /> 1 hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No <br /> dete�jnation of future system performance has been nor can be made due to unknown conditions during system construcfion, <br /> possible abuse of the system, inadequate maintenance, or future water usage. <br /> Inspector name: Josh Swedlund Certification number: C1659 <br /> Business name: Sewer Se ' s In �icense number: 2502 <br /> Inspector signature: Phone number: 952-873-3292 <br /> Nece�sary or Locally Required Attachments <br /> � Spil boring logs � System/As-built drawing � Forms per local ordinance <br /> ❑Other information (list): _._ __ <br /> www.p�a.state.mn.us • 651-296-6300 • St10-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats <br /> wq-wwi;ts4-31 • 3/16/12 Page 9 of 3 <br />