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v <br /> � " Minnesota Pollution Compliance Inspection Form <br /> `d�"°�� Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems <br /> St Paul,MN 55155-+4194 ($$T$� <br /> Doc Type:Compliance and Enfo�ement <br /> �_ ____� <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCAj � For local tracking purposes: <br /> requirements and attached forms—additional local requiremenks may also apply. ; <br /> Submit completed form to Local Unit of Govemment(LUG)and system owner <br /> withln 15 days <br /> $y5t@Rl $tdtUS <br /> System status on date(mm/ddlyyyy): 8115/2018 _ <br /> � Compliant-Certificate of Compliance ❑ Noncompliant-Notice of Noncompliance <br /> (Velid for 3 years fiom report date, unless shorter dme (See Upgrade Requirements on page 3) <br /> frame outlined in Local Ordinance.) <br /> Reason(s)for noncompliance(check a/l applicable) <br /> ❑ Impact on Public Health(Compliance Component #1)—lmminent threaf to public health and safety <br /> ❑Other Compliance Conditions(Compliance Component#3)—Imminent fh�at to pu6fic hea/th and safety <br /> ❑Tank Integrity(Compliance Component #2)—Faiting to profect grr�undwater <br /> ❑Other Compliance Conditions(Compliance Componenf#3)—Failing to protect groundwater <br /> ❑Soil Separation(Compliance Component #4)—FaiJing to protect groundwater <br /> ❑Operating permiUmonitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or SecJTwp/Range: 2911823410005 __ <br /> Property address: 3240 Sixth Ave. N.,Orono,MN• ___ ___ Reason for inspection: Property Transfer� <br /> Property owner: Mary Monahan __ Owner's phone: 812-940-0458 <br /> or <br /> Owner's representative: Representative phone: __ <br /> Local regulatory authority: City of Orono _ Regulatory authority phone: 952-249-4600 <br /> 2-1000 gallon septic tanks,l-1000 gallon lift station and 380 square feet of mound rockbed.per city <br /> Brief system description: records <br /> Comments or recommendations: � <br /> TBM:Top of the lift station manhole cover. I drilled through the rack bed and found the original grade at 101.0.7he bottom of the <br /> rock bed is at 102.4.There is 1.4 feet of sand under the rock bed.The City has no tank pumping records.The septic tanks should <br /> be pumped. <br /> Certification <br /> !hereby aertify that a!!the necessary i»fo►mafion has been gather�ed to determine the compliance status of this system. No <br /> determination of future system perfom�ance has been nor can be made due to unknown conditions duRng system construcfion, <br /> possib/e abuse of the system,inadequate maintenance,or future water usage. <br /> Inspector name: Joseph J Olson Certification number: 1255 <br /> Business name: Rus Olson's Soil 8 Perc.Testing License number: 810 <br /> Inspeotor signature: Phone number: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> �Soil boring logs �System/As-buiit drawing ❑ Forms per Iocal ordinance <br /> ❑Other information(list): _ _ <br /> __ _ _ _ __. __ <br /> www.pca.state.mn.us • 651-296•6300 • 800-657-3864 • TTl'b51-282-5332 or 800-b57-3864 • Availabte in attemative formats <br /> wq-wwists4-31 • 1/?4/92 Page 1 of 3 <br />