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{�� , ��.� Minnesota Pollution COrpp�laClCe �I'1SpCCt1011 FOrI'1'1 `�,;e.M.p Control Agency 520 Lafayette Road NorEh Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55]55-4194 Doc Type:Compliance and Enforcement InspeCti�n re8ults based on Minnesota Pollution Control qgency(MPCA) For local tracking purposes: requirements and attached forms—additional local requirements may also apply. Submit comp�eted form to Local Unit of Government(LUG)and system owner within 15 days System Status System status on date(mmldd/yyyy): 5/30/2017 � Compliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) frame ou#lined in Local Ordinance.) Reason(s)for noncompliance (check aU applicab/e) ❑ Impact on Public Wealth (Compliance Component#1)—Imminent threat to public health and safety ❑Other Compliancs Conditions(Compliance Component#3)—Immrnenf threat to public health and safety ❑Tank Integrity(Compliance Component#2)—Failing to protect groundwater ❑Other Compliance Conditions(Compliance Component#3)—Failing to protect groundwater ❑ Soil Separation(Compliance Component#4)—Failing to protect groundwater ❑ Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant Property Information Parcel ID#or Sec/Twp/Range: Property address: 4440 Bayside Road,Orono Reason for inspection: Sale Property owner: David Montecalvo _ Owner's phone: 952-472-0219 or -- _� Owner's representative: _ Representative phone: _— Local regulatory authority: City Regulatory authority phone: Brief system description: _2-1000 gal septic tanks& 1000 gal pump tank with a mound system Comments or recommendations: — Certification I hereby certify that all the necessary information has been gathered to determine fhe compliance status of this system. No determination of future system performance i►as been nor ean be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Josh Swedlund Certification number: C1659 Business name: Sewer S ' s License number: 2502 Inspector signature: _ Phone number: 952-873-3292 Necessary or Lo ally Required Attachments � Soil boring logs � System/As-built drawing � Forms per local ordinance ❑ Other information (list): www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Availabie in atternative formats wq-wwists4-31 • 3/16/t2 „___ , _�,