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Minnesota Pollution Compliance Inspection Form <br /> Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems <br /> St.Paul,MN 55155-4194 (SST$) <br /> Doc Type:Compliance and Enforcement <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPGA) 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 <br /> System Status <br /> System status on date(mm/dd/yyyy): 5/12/2017 <br /> 77 Compliant—Certificate of Compliance (g! 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 /> [I Impact on Public Health (Compliance Component #9)—Imminent threat to public health and safety <br /> ®Other Compiiance 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 /> 21 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: 3311823440037 <br /> Property address: 120 Truffula Trail, Orono, MN Reason for inspection: Property Transfer <br /> Property owner. Frederick Dufault Owner s phone: _210-683-7550 <br /> or _.. ___ <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: __jqity of Orono ., _ Regulatory authority phone: _952-249-4600 <br /> Approximately 2-1300 gallon septic tanks,1-1300 gallon lift station and approximately 680 square feet <br /> Brief system description: of mound rockbed. <br /> Comments or recommendations: <br /> The north end of the rock bed has 1.0 feet of sand and the south has 1.5 feet of sand under the rock bed.The south side of the rock <br /> bed is mottled at the original grade.Therefore there is 1.5 feet of separation. <br /> Certification <br /> l 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&Pero.Testing License number. $10 <br /> - <br /> Inspector signature: ---- Phone number: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> Soil boring logs ®System/As-built drawing ❑ Forms per local ordinance <br /> 7 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-wwists4-31 - 1124112 Pae,* 1 of 3 <br />