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Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems St.Paul,MN 55155-4194 ($$T$� . Doc Type:Compliance and Enfor�ement Instructions: Inspection results based on Mi�nesoia Pollution Control Agency(MPCA) For local tracking purposes: requirements and attached forms-additionai local requirements may also apply. Submit completed form to Local Unit of Government(LUG)and system owner within 15 days System Status System status on date(mmldd/yyyy): 8l812018 � Compliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance (Valid for 3 years from report date, unless shorter fime (See Upgrade Requirements on page 3) frame outlined in Local Ordinance.) Reason(s)for noncompliance(check all applicable) ❑ Impact on Public Health (Compliance Component #1)-Imminent threat to public health and safety ❑Other Compliance Conditions(Compliance Component#3)-Imminent threat to public health and safety ❑Tank Integrity(Compliance Component #2)-Failing to protect groundwater ❑Other Compliance Conditions(Compliance Component#3)-Failing to protect groundwater ❑ Soil Separation(Compliance Component #4)-Failing to protect groundwater ❑ Operating permiUmonitoring plan requirements(Compliance Component #5)-Noncompliant Property Information Parcel ID#or Sec/Twp/Range: _0411723240019 ___— _ _ Property address: 2915 Somerset Lane, Orono, MN Reason for inspection: Property Transfer - ---- Property owner: Andrew Mills Owner's phone: _612-508-6607 — - ---- _ _ -- -- . — --- — or Owner's representative: Jeff Stalberger_ _ Representative phone: 763-442-9458 --- _ _ _ _. Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 _-- — _ _—_ _ — Approximately 2-1250 gallon septic tanks,1-1500 gallon lift station and 750 square feet of mound Brief system description: rockbed. Per ci�records _ _ --- -__ - -- -- Comments or recommendations: TBM: Bottom of the rock bed.The system has 1.0 feet of sand. Certification 1 hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system pe�formance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Jose h J Olson Certification number: 1255 Business name: Rust�i O son's Soil&Perc.Testing License number: 810 __ __ _ _— - . _ - — Mspector signature: --'- Phone number: 763-498-8779 Necessary or Locally Required Attachments � Soil boring logs � System/As-built drawing ❑ Forms per locat ordinance ❑Other information (list): _ _ __ _ ---- _ .-- —__ — www.pca.state.mn,us • 651-296-6300 • 800-657-3864 • TTY 651-282•5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • i/24/12 Page 1 of 3