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� 05/01/2014 07:03 9528733112 PAGE 61/04 <br /> �� Minnesata Potiution Compliance Inspectian Form <br /> contrcl Agency <br /> 520LafayetieRoedNarth ����t��g Subsurface Sewage Treat�t�nt Systems (SSTS) <br /> St.Paul,MN 55155�194 Doc Type�Compliance and E»fprCement <br /> For local track � <br /> Itlsp�c#ion resultS b�sed on Mlnnesota Pollutian Control Ag�ncy(MPCA) ��ED <br /> r$quirements and attached forrns—additional Iocal roquirements may also apply. <br /> Submlt completed form tp LoCal Unit vf Government(LUG)and system own�r J�� ? � i(���: <br /> withfn 15 deys <br /> CITI'OF ORONO <br /> System Status <br /> System st�tus on date(mrnlddlyyyy): 5/1/2pi4 <br /> �f Compliant— Certificate of Compliance ❑ �oncoimpliant— Nvtioe af Noncampliance <br /> (Valid fnr 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) <br /> irame outlirred in Loca!Ordinance.) <br /> �#easan(s)for noncompliance (check aD applicable) <br /> [] Impaat on Public Health(Compliance C�mponent#1)—lmminent threat to public healih and safety <br /> ❑Other Compfiance Conditions(Gomplian�e Component#3)—lmmrnent fhreat to publrc health and safety <br /> ❑Tank Integrity(Complianae Gomponent#2)—Fail�ng to protect groundwater <br /> ❑Other Compliance Conditions(CompGance Componenf#3)—Feiling to protect groundwater <br /> Q Soil Separation (Compliance Component#4)—Farling to protecf groundwater <br /> (�Oper�ting permi�/monitoring plan requiremants(Compliance Component l�5)—Noncompliant <br /> Property In�Formatian Parcel ID#or Sec/Twp/Range: <br /> Prop�rty address: 125 Goldan ViEw Drive-Long Lake Reason for inspection: sale <br /> Property awner; �Cra�Johnson__ __ Owner's phone: � ���^ M^ <br /> or _.._ �._� <br /> Qwner's representative; Representative phone: <br /> Lacal regulatory authority: Counry pegufatory authority phone: <br /> Brief system descriptio�: 2- 7�00 septics& 1004 pump tank,mound system <br /> Comments or recommiendations: <br /> Mound onfy had about 6"of dlrt over�ockbed instead of the 18" required when installed. Adding 12"of topsoil to mound would help <br /> protect from freeaing. This does not cause the system to tail compliance <br /> Certification <br /> 1 hereby certiFy that a!f the necessary information l�as been gathered to determine the cvmpliancs status of thrs system_ No <br /> determrnafion of luture systam parformance has beeR nor can be made due to unknown condirions during system construcr;on, <br /> possibfe abuse o!the systern, inadequate mairrtenance,or fu#ure water usaQe. <br /> Inspector name; Josh Swedlund Certification number: C1659 <br /> Business name; Swedlun ti rv' Licenss number: 2502 <br /> Inspector signature: Phone number; 952-873-3�9a <br /> Necessary or Locally Required Attachments <br /> �Soil boring logs �System/As•built drawing � Forms per local ordinanCe <br /> ❑Oth�r information(list}: � ����� ��� � <br /> www.p�asta[e.mn.us . 651-296•b300 . 800-657-3864 . TTY 651•282-5332 Or$00•657•3864 • Available�n altemati�e formats <br /> wq-wwists4-31 • 3J 16/12 Page l of 3 <br />