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Apr 17 15 09:40a 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 /> St.Pau I,MN 551554+194 (SSTS) <br /> Doc Type:Compliance`` and enforcement <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local trac rlrciblie ED <br /> requirements and attached forms—additional local requirements may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owner APR 1 6 2015 <br /> within 15 days <br /> CITY OF ORONO <br /> System Status <br /> System status on date(mmlddlyyyy): 4/1612015 <br /> ® Compliant—Certificate of Compliance ❑ Noncompliant—Notice of Noncompliance <br /> (Valid for 3years 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 Parcel ID#or Sec/Twp/Range: 0411723420014 <br /> Property address: 2785 White Oak Circle,Orono,MN _ Reason for inspection: Property Transfer <br /> Property owner: John Dougan Owner's phone: 952-473-0355 <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 /> 1 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: Rus son's Soil&Pero.Testing - License number: 810 <br /> Inspector signature: 1 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 • Available in alternative formats <br /> wq-wwlsts4-31 • 1/24/12 <br /> Pagel of 3 <br />