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05/22/2613 08: 51 9528733112 % PAGE a1/03 <br /> � � `� <br /> t �. �• <br /> Minnesota Pollution `�r �� ����� �ns ection Form <br /> �r�,.� L� Com pl p <br /> ' � - Cantrol Agen�y <br /> ,.. Existing Subsurf�ce Sewage Tre�atmer�� Systems (SSTS) <br /> ,zp Lafayette Road North <br /> St,Paul,MN 55155-4194 Doc Type:Compliance and Enforoament <br /> Ittspection results based on Minnesota Pollution Control Agency(MPCA) <br /> �F'or Incal tracking purposes: � <br /> requitements and attached forms-additional 1oc21 requirements may also apply. <br /> Submit complated farm to Local Unit of Government(L.uG)and system owner — - - <br /> within 15 days '--� �� � -- <br /> System Status <br /> System status on date (mmlddlyyyy): 5/17/2013 , . <br /> � Compliant— Cer�ifiicate of Compliance ❑ Noncompliant— Nofiice of Noncompliance <br /> (Va6d for 3 years from reparl date, unless shorter time (See Upgrade Requrroments on page 3.) <br /> frame outlrned in�acaf ardinance,) <br /> Reason(s)for noncompliance (check all applicable) <br /> ❑ Impact�n Public Health (Compliance Gomponenf#1)-lmminent threa�to public healih and saf�lY <br /> ❑ Other Compliance Conditions(Compliance Component tt3)-Imm�nenf threat to pub�rc health and safety <br /> ❑Tank Integrity(Compli�nce Camponent#2)-�arlrng to prafect gmundwater <br /> ❑Other Compliance Co�ditions (Compliance Cornponer�f#3)T Failrng to protect groundwater <br /> 0 Soil Separation{Comp�iance Component#4)-Fairing to protect groundwafer <br /> ❑ Oparating permitlmonit4ring plan requirements(Complience Componant�5)-Noncompliant <br /> Property Information Parcel ID#or Sec1�'wplRange: __ ____ __ . —_ --- <br /> Property address: 1510 Green Tree Ro�d Reason for inspection; Sale _ _.._ . _ <br /> J � .. . <br /> . — <br /> --. <br /> Property owner; Nancy Danko Owner's phon�: 952-�49-OD20 . . _.._...- <br /> or <br /> Owner's representative; _._„ Representative phone; _ . <br /> _. ----- __ _.. — <br /> Local regulatory autnority�. City Reguiatory autharity phone: - <br /> Brief system description. _. ��— - -�-- <br /> Comments �r recommendatians; <br /> Certification <br /> I hereby certify that aA fhe necessary inFormation hr3s been g�thered to determine the compfrance status af fhis system, No <br /> determination of future systam performarrce has boen nor can be made due to unknown canditions durfng systCm constn�Ction, <br /> possible abuse of the system, rnadequatQ maintenance, orfuturc waterusage. <br /> Inspectorname: Josh Swedl _ _ Certificatian number. C1659 _ <br /> —. . <br /> Business nama: Swedlun t� S�rvi License number. 2502 _,. .__ .__ <br /> - -- --- ---- - <br /> InspeCtor signature: Phone number; 952-873-3292 _ <br /> Necessary or l�ocally Required Attachments <br /> � Soi1 boring logs � SystemiAs-buift drawing � Forms pQr local ordinance <br /> ❑ Other information (fist): _ ____. _.— ___..— -. �-- <br /> _ _.._... ._._. _...-------_. _.. _ _ .. — <br /> www.pca.state-rtm.us • 651-Z96-6300 • 800-657-386n . TTY 651-28J.-533Z or 840-657-386�� • Available�n alternative formats <br /> ...........:_..e_�, _ vi,a�,� o��� t.,4'1 <br />