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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 (SSTS) <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 (mmlddlyyyy) <br />1/21/2020 <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 Ordinance.) <br />Reason(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 permit/monitoring plan requirements (Compliance Component #5) — Noncompliant <br />Property Information <br />Property address: 3060 Sixth Ave. N.., Orono, MN <br />Property owner: <br />or <br />Chris & Heather Kosek <br />Parcel ID# or Sec/Twp/Range: 2811823320014 <br />Reason for inspection <br />Owner's phone: <br />Property Transfer <br />763-670-0444 <br />Owner's representative: Representative phone: <br />Local regulatory authority: City of Orono Regulatory authority phone <br />952-249-4600 <br />Approximately 1-1250 gallon 1-1000 gallon septic tanks,1-1250 gallon lift station and approximately <br />Brief system description: 630 square feet of mound rockbed. <br />Comments or recommendations: <br />TBM: Top of garage concrete slab. The rock bed has 1.0 feet of sand under it on the West end and 2.0 feet of sand on the East <br />end. The existing septic tanks are starting to corrode. They are still compliant but will need to be replaced sometime in the future. <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 <br />Certification number: 1255 <br />Business name: Rusty OIs n'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 • Avaitable in alternative formats <br />wq-wwists4-31 • 1124112 Page 1 of 3 <br />