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Minnesota Pollution Compliance Inspection Form <br /> Control Agency <br /> A-7_ Existing Subsurface Sewage Treatment Systems (SSTS) <br /> 520 Lafayette Road North <br /> St.Paul,MN 55155-4194 Doc Type:Compliance and Enforcement <br /> 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 L <br /> System Status <br /> System status on date(mm/dd/yyyy): 1/23/2019 <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 /> ❑ Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: 1011723320014 <br /> Property address: 1270 French Creek Drive Reason for inspection: Property Transfer <br /> Property owner: Matt Peterson Owner's phone: 914-406-3545 <br /> or <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 <br /> Brief system description: Approximately 3-1000 gallon septic tanks,1-1250 gallon lift station and 24X46 feet of chamber bed _ <br /> Comments or recommendations: <br /> TBM:Top of door threshold. I meet Roger Peitso.The building inspector at the site for soils verifiction. It was the consensus that the <br /> periodically saturated soils were located 64 inches below grade. <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: Joseph J Olson Certification number: 1255 <br /> Business name: Rusty Olson's Soil& Perc.Testing License number: 810 <br /> Inspector signature: _ Phone number: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> 0 Soil boring logs ® System/As-built drawing ❑ Forms per local ordinance <br /> 0 Other information (list): <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-wwists4-31b • 6141/14 Page 1 of 3 <br />