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Dec 1812 04:04p Joseph Olson 763-498-8290 p.2 <br /> Minnesota Pollution Com Bance Inspection Form <br /> Control Agency P P <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems <br /> St.Paul,NIN 55155-4794 (SSTs) <br /> Doc Type:Compliance and Enforcement <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <br /> requirgments and attached forms—additional local requirements may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owner <br /> within 13 days <br /> System Status <br /> System status on date(mm/ddlyyyy): 1 211 312 01 2 <br /> Compliant—Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance <br /> " (VWid for a years firorfi'i2perrt date, unless shorter time (See Upgrade Requirenliks on page 3) <br /> frame outlined in Local Ordinance.) <br /> Iteason(s)for noncompliance(check all applicable) <br /> ❑ Impact on Public Health(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 permitlmonitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Prpperty Information Parcel ID#or SecfTwp/Range: 32-118-23-34-0012 <br /> Property address: 3743 Watertown Road,Orono, M,N _ Reason for inspection: Property Transfer <br /> Property owner. Lorna Butterfield Owner's phone: 612-718-9867 <br /> or <br /> Owner's representative. Representative phone: <br /> Local regulatory authority. City of Orono Regulatory authority phone: 952-248-4600 <br /> 2-1000 gallon septic tanks,9-1000 gallon lift station and 380 square feet of mound rockbed.per city <br /> Brief system description: records <br /> Comments or recommendations: <br /> Viµ; <br /> Certification <br /> I 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'SW&Perc.Testing License number ' 810 <br /> Inspector signature: - Phone number. 763-498-8779 <br /> I ;.` <br /> Necessary or Locally Required Attachments <br /> ®,Soil boring logs ®System/As-built drawing ❑Forms per local ordinance <br /> (3 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 />