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:�, �►►innesota Poilution Compliance Inspection Form <br /> Control Agency <br /> 520lafayette Road Nortfi Existing Subsurface Sewage Treatment Systems <br /> SL Paui,MIV 55155-4194 (SSTS) <br /> Doc Type:Compiiance and Enforcement <br /> Instn�ctions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <br /> requirements and attached forms-additional local requirements may also apply. E <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): 3J712017 <br /> � Compfiant—Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance <br /> (Valid for 3 years from report date, unless shorter time (See tJpgrade Requirements on page 3) <br /> frame ouflined in Local Ordinance.) <br /> Reason(s}for noncompliance(check al!applicabte) <br /> ❑ Impact on Public Health(Complrance Component #t)-lmminent threat to public health and safety <br /> ❑Other Compliance Conditions(CompJiance Component#3)-tmminent threat to public health and salety <br /> ❑Tank Integrity(Compfiance Component #2)-Failing to prvtecf groundwater <br /> ❑Other Campliance Conditions(Campliance Component#3)-Failrng to protect groundwater <br /> ❑Soil Separation(Comp/iance Component #4)-Failing to protect groundwafer <br /> ❑Operating permiUmonitoring plan requirements(Comp(iance Component #5)-Noncompliant <br /> Property Information Parce!ID#or SecJTwp/Range: 2511823330003 <br /> _� <br /> Property address: 625 Spring Hill Road, Orono,MN Reason fior inspection: Prope�Transfer <br /> Property owner: Van Zandt&Elizabeth Nawn Owner's phone: 612-379-0062 <br /> -- . �.. _.- --- - a _�__. __._.._._._._.__ <br /> or <br /> Owner's representative: Representative phone: <br /> _. _ . <br /> Local regulatory authority: City of Orono __ Regulatory authoriry phone: 952-249-4800 <br /> --- - — _...... <br /> Brief system description: 2-1__OQO gallon septic tanks and approximately 727 Squarel fest of trench_per ci _records <br /> . _ _. __--- <br /> Comments or recommendations: <br /> The maximum depth of the trenches are 30 inches deep. Three soii borings in the area of the septic system found that the <br /> periodically saturated soils are greater than 5.1 fest below grade. <br /> Certification <br /> 1 hereby certify that all fhe necessary information has been gathered to deterntine the cvmp6ance 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 /> possib/e abuse of the system,inadequate mainfenance, or future water usage. <br /> Inspector name: Joseph J Olsan Certification number: 1255 <br /> Business name: Rust Olson's Soil$�Perc.Testing License number. 810_ ` <br /> . .__ <br /> Inspector signature: ___ Phane number: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> �Soil boring logs � System/As-built drawing ❑ Forms per local ordinance <br /> ❑Other information(list): <br /> _ - _ _—__ <br /> --- - _.__ -- . . _..___---_ -- _._.._ ..... <br /> www.pcastate.mn.us • 651-296-6300 • 800-657-3864 • T7Y 651-282-5332 or 800-657-3864 • Available in attemative formats <br /> wq-wwists4•31 . t/24/t1 Page 1 of 3 <br />