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Ju1051210:14p JAseph Olson �(� ���' 763-498-8290 p.2 <br /> , � r � <br /> � ' � <br /> iVlinnesota Poitution � • <br /> Contraf Agency � ` ompl�ance Inspection Forr� <br /> 520 lafayette Road North ♦ xisti ng Subsurface Sewage Treatment Systems <br /> 5L Paul,MN 55155-4794 {SSTS� <br /> Doc Type:Compliance and Errforeement <br /> Instrucfions: InspecFion results based an M Pallution Cordrol Agency(MPCA) For local tracking purposes: <br /> requiremer�ts and attached furrns—additional loca�requirements rnay also appfy. <br /> Submit complebed form to Local Unit of Gavernment(LUG)and system ow�eer <br /> within'f5 ciays <br /> System Status <br /> System status on dabe(rrimlddJYYYlI)� 8/29/2012 <br /> ❑ Compliar�t—Certificate of Compliance � Noncompliant—Notice of Noncompliance <br /> (Valid fo�3 y+ears from r�port date, unless shorte�(ime (See Upgrade RequirEmer►ts on page 3J <br /> �rame oudined in Loca/OrdiRance.) <br /> Reason(s�for noncompliance(cfreck a/l applicable) <br /> �lmpact on Public Health (Compliance Component #9)—lmminenf threat fo pu6lic healfh and safety <br /> ❑Other Complianoe Cortditions(Compliance Component#3)—Imminerrt threat ta publrc health and safety <br /> ❑Tank Jntegriry(CompJiance ComFonent #2)—Faling to protect groundwafer <br /> ❑Other Campliar�ce Conditions(Compliance Componenf#3)—Far7fng to protectgroundwater <br /> ❑ Soii Separa6on(Compliance Cvmponenf #4)—Failing to profecf graundweter <br /> ❑ Operating permiUmonitoring pla�requirements(Compliance ComAonent #5)—Noncompliani <br /> Property lnformation Parcel fD#or SedTwp/Range: 32-'118-23-21-0005 <br /> Praperty address: 605 Stubbs 8ay Road N., Orono MN Reason for inspedion: Property 7ransFer <br /> Properiy owner. Hank�wrted Owners phone: <br /> or <br /> Owne�'s representative: The Relacation Genter Representative phone; 952-4-73-1766 <br /> Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 <br /> 2-7000 gallon septfc tanks,l-1000 gallon fiR station ar�d 38�square feet of mound rockbed.per aty <br /> Brie#system description: reoords <br /> Comments or recommendations: <br /> The pump is m"�ss�ng in the lift station.The system wil�not iunc5on with out a pucnp_Once the p�mp is nepiaced the systecn will be <br /> camp6ant. <br /> tertification <br /> I hereby certify that all the necessary infamation has been gathened fo de[ermine the compliance status of this sysfem. No <br /> determination pffulur�system performarrce has been nor can be made due fo unlmown conditians dr�ring sysfem cbnstructior+, <br /> possi6le ab+�se of fhe system,inadequate maintenance, or futur+e waie�usage. <br /> inspectorname: Joseph J Olson Certification number: 1255 <br /> Business narne: Rus O on's Sal &Perc.7estin License number. 810 <br /> Inspector sig�ature: P#�one number: 763�-498-$779 <br /> r <br /> Necessary or Locaily Required Attachments <br /> �Soil boring fogs �Syslem/As-built drawing ❑ Forms per local ordinance <br /> ❑Other information (list): <br /> www.pca.stdte.mn_us • 651-2%-6300 • BfJC-657-3864 • TTY 651-262-533Z or 8U0-657-3664 - Availabte in altemative fonnats <br /> ,..,......._._. �� . .,�.,.-, <br />