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Mailing Address Street Address Certificate of Compliance <br /> P.O.Box 66 2750 Kelly Parkway <br /> Crystal Bay,MN 55323 Orono,MN 55356 I nspection Form <br /> Phone:952-249-4600 Fax:952-249-4616 <br /> 4'4K£st{0Ye Website: www.ci.orono.mn.us New Subsurface Sewage <br /> Treatment Systems (SSTS) <br /> Inspection results based on Minnesota Pollution Control Agency(MPCA)requirements and attached <br /> forms System status on date 06/05/2019: <br /> Compliant—Certificate of Compliance n Noncompliant— Notice of Noncompliance <br /> Valid for 5 years from report date (See Upgrade Requirements on page 3.) <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#3)—Imminent threat to 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 protect groundwater <br /> ❑Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: <br /> Property address: 1180 Homestead Trail Reason for inspection: New Istallation <br /> Property owner: Owner's phone: <br /> or <br /> Owner's representative: Jake Carlson Representative phone: 763-229-2515 <br /> Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 <br /> Brief system description: Type I mound <br /> Comments orrecommendations: <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: Roger Peitso Certification number: #C6683 <br /> Business name: License number: <br /> Inspector signature: �'j`2 �u Phone number: 952-249-4625 <br /> Necessary or Locally Required Attachments <br /> ®Soil boring logs II System/As-built drawing <br /> ❑ Other information(list): <br /> Page 1 of 3 <br />