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Parcel number: 2611823320012 System status: ®Compliant ❑Noncompliant <br /> (as determined by this fort) <br /> Hydraulic Performance and Other Compliance <br /> Compliance Issue#1 of 4 <br /> Date of observation: 10/06/10 Reason for observation: Property Transfer <br /> This far expires upon next inspection or in three years,whit hem occurs first 10/06/13 <br /> Compliance questionelcriteria: (Required) Verification Method': (Optional) <br /> Check the appMpnate box (Check the appropriate box) <br /> Does the system discharge sewage to the ❑Yes ®No ® Searched for surface outlet <br /> round surface? <br /> Does the system discharge sewage to drain ❑Yes ®No ❑ Performed hydraulic test <br /> file or surface waters? ® Searched for seeping in yard <br /> Does the system cause sewage backup ❑Yes ®No ® Checked for backup in home <br /> into dwellingor establishment? ❑ Excessive ponding in soil system/l)-boxes <br /> Do other situations exist that have the ❑Yes ®No ❑ Homeowner testimony <br /> potential to immediately and adversely <br /> impact or threaten public health or safety ❑ Examined for surging in tank <br /> electrical,unsafe covers,etc.)? <br /> ❑ `Black soil'above soil dispersal system <br /> Any"yes-answer indk otes that the system is an imminent <br /> threat to public health and safety. ❑ System requires"emergency"pumping <br /> ❑ Performed dye test <br /> Does the system pose a threat to grand ❑Yes ®No ❑ Other <br /> waw fa'any corm deemed non- <br /> protective determined bythe <br /> Wes-indicates that the systema failing to protect <br /> ground watt.If"yes';describe the condition noted: <br /> *No standard protocol exists. This list is not exhaustive, <br /> in sequential order,nor does it indicate which <br /> combinations are necessary to make this detemdnation. <br /> Cert fication <br /> This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance <br /> Inspection Form for Existing Subsurrface Sewage Treatment Systems_Observations.irrtdarpretations,and conclusions must be <br /> completed by an inspector Completed form must be submitted to the local unit of government within 15 days. <br /> Property owner name(s): Daniel&Rebecca Bolgar <br /> Property address: 1560 Tanglewood Road Orono,MN 55356 <br /> Property owner's address(if different): <br /> County: Hennepin Phone: 952-476-0676 <br /> 1 hereby certify that I personally made the observations,k9erpretalions,and conciumons reported on this form and that they are <br /> corect <br /> Name: Joseph J Olson Certification number: 1255 <br /> Business ficanw name and number: Rusty Otsat's soil and perc ulation Ming Lie#810 or <br /> Name of local unit of government City of Orono <br /> Signature: Date: 10/09/10 <br /> wq-wwists4-31 Compliance Inspection Form for Existing IM <br /> 414108 <br />