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��r���sc��a �e�����ic�n �.C3 ���l1C� ����3E'���(J�1 F �'�1'll <br /> �c�ntrt�! A,gency <br /> ���:`���v-����a��o�,� �xist�ng �ubs�rfac� �� ��e Tr��t �r�t Sys��ms <br /> St.Pa�eE,��i 55?55-4f94 ���'�$} <br /> Doc�ype:Comptiance and Enforcement <br /> . ___._ _ ___._ <br /> Er�s�ructiorss: lnspect;on resuits based fln Minnesa4a PoEI�`io.�Corttrol Agen�y(MPCA? Far{ocai iracl�ing purpc�ses: <br /> reauiremerts and attached forms—acsd'rtianai Ic>�a9 requirernen,s may a#so apply. ; <br /> S�atsmif cos�p�eted gor�n to i.�ea� �1nit of Gover�ment(a..B'G)ar��systear�owner � <br /> withi�a't 5 days , <br /> $�5'��3Tt S�d'�t15 <br /> Sys�er�s�tus arr date(Gnen/r�dZy�yy`�: 5i2�1201? <br /> � Corr�p�l6ant— �ertifcate �f�omp3iance � 9�ancomp�iar�t— #Voti�� c�f Noncoe�a�8�ance <br /> ;Jalid far 3 ysars from report date, unless shflrl�r time (S�e ilpgrac'e f?equir�ments ar�page 3) <br /> frame outlired rn Locat Ordinance.} <br /> Rea�ara�s)��r nonce�mQlianc� (check atd a��lic�bl�� <br /> � im�act an Fubiic i-iealth (Casnpllance Component #1)—lmminent threat to pubtic h�alth arzd safety <br /> � Gther Cmmpliance Conc�it}ons(Compliance Componen�#3)—imminerzt threat to publie health and safery <br /> �Tank integrsty(Compliance Component #2)—Faiting��proteci groundwater <br /> J �iher�ornpliance Condit'sons(Cornp9iance Camponen[#3)—Farling to protect groaenrlwr��er <br /> ;J Sai(Sep�:atian (ucmptrance Cornponent #��—Farting to proteci ground�rrater <br /> ;_i ��eraiing permi�tm�nitorir�g pfan re�uiremenis(Compliance�omponer�t #5}—Noneomptlanr <br /> �f0�32i"Cy !i1'�OftT2�$20F� oarcet I�#or SeclTwp/Range: �31�972322�t�25 <br /> _.____- — ___ <br /> �rop�r�y address: 2295 Longv_iew Circle; Oronc,MN _ _ � �2eason for inspeciion: Propert�ransf�r__ <br /> _ _ _—..� �._ _ <br /> �rcp�ry awner� Sarb Gugan _�_._._ _ _ _.__.__ vwner's hone: 612-205-5446 <br /> arP ___ ...._.._ _ ---- <br /> C7v�i��r's representative: --- m__.�.__� ..._ _�. �epresentative phone: <br /> _ .._ ____ � <br /> �ocai reg�iatory a�:t�:ori,ry: _City_�f Qrorto__ _..____. —__----- �egulatary a�sthority phone: 952-249-4600 <br /> ___— ..... — <br /> 2-10G0 ga�fon septic:arks,l-',OGO gallon 6i€�station and 55J square feet of mound rockbed. per cit� <br /> Br�ef system descr�ption: records <br /> __ ____.__- __-_ __._ � --_ ___—_---. _._ __�____.__ ---- <br /> Comments or recammendaticsns: <br /> �ie�ch Mark is ihe iop of the€i{t station manhole cov�r. <br /> Certification <br /> f her�by certify that atl fhe necessary infarmation has been gather�d to��t�rmane fhe compfiance staius of this system. �tc <br /> �`et�:r�rnation of future syste�r perform�nce has been n�e c�n be rrrade du�to unknow�n conditions dunng system canscructior,. <br /> �ossible abuse of the system, rrra�equat�maintenance, a{future water usage, <br /> inspecior narr�e: __Jose�h J QI_son_ ___ ___. .w_ _.._.,.._,.__ �ertificatian number: ?255 <br /> ___—_ . <br /> Business name: Rusf Oison's Soii&��rc.Test�r��_ _._._,.. __�_ Lice�se r�urnber: 81� <br /> ___ _�__ _ <br /> ;nspectorsigr;ature� __—_ _ .__ . � ----.----__ ._..__--- Phcr�ers�m��r: 763-498-877� <br /> �iecessary or �aca��y Rer�c�ired ��fia�t�rt��ents <br /> � Soii boring�ags � SysterniAs-built drawing Q Fcrms per Iccaf ardinance <br /> � Ot�er information (€is�): <br /> _ —__ _—_._ __. __� _.._— . . __--. -- <br /> ._____ ____._ <br /> www.pca.stace.mr.::s • b5�-296-630G • 8p0-657-386� . 'a'TY b5'f-282-5332 or 800-657-38b4 • avaitaole in atterna�ive€armau <br /> wq-ww�s:s4•3J • 1124/1: t�ag� 7 of 3 <br />