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Aug 12 14 06:14p Joseph Olson 763-498-8290 p.2 <br /> Minnesota Pollution Compliance Inspection Form <br /> Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems <br /> SL Paul,MN 55155-4194 (SSTs) <br /> Doc Type:Compliance and Enforcement <br /> Instructions: tnspection 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 i <br /> System Status <br /> System status on date(mm/ddlyyyy): 6/25/2014 <br /> ® Compliant—Certificate of Compliance [] 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 Ordnance.) <br /> Reason(s)for noncompliance(check all applicable) <br /> ❑ Impact on Public Heafth(Compliance Component #1)—Imminent threat to public health and safety <br /> ❑Other Compliance 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 /> ❑Soil Separation(Compliance Component #4)—Failing to protect groundwater <br /> ❑Operating permit/monitoring plan requirements(Compliance Component #5)--Noncompliant <br /> Property Information Parcel Ipf#or Sec/TwpfRange: 04-117-23-22-0033 <br /> Property address: 3065 Watertown Road,Orono,MN Reason for inspection: Property Transfer <br /> Property owner: Chrysanne Manoles Owner's phone: 612-327-7779 <br /> or <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 <br /> 2-1000 gallon septic tanks,1-1000 gallon lift station and 380 square feet of mound rockbed. per city <br /> Brief system description: records <br /> Comments or recommendations: <br /> Certification <br /> f 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: _RysN O son's Soil& Perc.Testing License number: 810 <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 /> ❑Other information(list): <br /> www.pca.state.mn.us • 651.296-6300 • 800-657-3864 TTY 651-282-5332 or 800-657.3864 • Avaitabte in alternative formats <br /> ivq-wwl5ts4-31 • 1/24/12 Page t of 3 <br />