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2 of 11 <br /> Minnesota Pollution Compliance Inspection Form <br /> Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems <br /> St.Paul,MN 55155-4194 (SSTS) <br /> Doc Type:Compliance and Enforcement <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <br /> requirements and attached forms—additional local requirements may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owner <br /> within 15 days <br /> System Status <br /> System status on date(mmldd/yyyy): 5/16/2018 <br /> ® Compliant- Certificate of Compliance ❑ Noncompliant- Notice of Noncompliance <br /> (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3) <br /> frame outlined in Local Ordinance.) <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 /> 0 Operating permit/monitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: <br /> Property address: 1235 Lyman Avenue, Orono, MN 55356 Reason for inspection: Property Transfer <br /> Property owner: Owner's phone: <br /> or <br /> Owner's representative: Structure Tech Representative phone: 952-915-6466 <br /> Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 <br /> Brief system description: Two pre-cast septic tanks,a pre-cast lift tank, and a mound. <br /> Comments or recommendations: <br /> According to city records,the mound surfaced in 1987 and at the time additional fill was brought in for the base of the mound. No reports of <br /> surfacing have been reported since.Although not a compliance criteria,the lift pump alarm may not be working properly. The alarm should be <br /> verified that it works and if found not working it should be replaced as soon as possible to notify the occupants of the house in the event of a pump <br /> malfunction. In addition,there are two large trees adjacent to the mound red bed and a cluster of smaller trees on the rock bed that should be cut <br /> flush to the ground,taking special care that no equipment be driven on the mound. <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: Brian Humpal Certification number: L5342 <br /> Business name: Inspect Minnesota, Midwest Soil Testing License number: L2896 <br /> Inspector signature: ,a,` Q Phone number: 651-492-7550 <br /> Necessary or Locally Required Attachments <br /> ® Soil boring logs ® System/As-built drawing ❑ Forms per local ordinance <br /> ® Other information(list): Report Summary, Property Information, Disclaimer, License <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • 1/24/12 Page 1 of 3 <br />