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03/13/2015 12:21 9528733112 <br />A011Wil Minnesota Pollution <br />Control Agency <br />520 Lafa" Road North <br />St. Paul, MN 551554194 <br />PAGE 01/03 <br />Compliance Inspection Farm <br />Existing Subsurface Sewage Treatment Systeme (SSTS) <br />DOC Type. Compliance and Enforcement <br />Inspection results based on Minnesota Pollution Control Agency (MPCA) For local track;ng purposes: <br />requirements and attached forms — additional locai requirements may also apply, <br />Submit completed form to Local Unit of Government (LUG) and system owner ����� 3 Za pJ <br />within 15 days CITY Q <br />F ORONO <br />System Status <br />System status on date (mmlddiyyyy): 3/10/2015 <br />❑ Compliant — Certificate of compliance <br />(Valid for 3 year.5 from report date, unless shorter time <br />frame outlined in Local Ordinance,) <br />® Noncompliant — Notice of Noncompliance <br />(Sea Upgrade Requirements on page 3.) <br />Reason(s) for noncompliance (check By applicable) <br />El impact on Public Health (Compliance Component #9) — Imminent threat to public health and safety <br />0 Other Compliance Conditions (Compliance Component #3) — Imminent threat to public health and safety <br />© Tank Integrity (Compliance Component #2) — l=ailing to protect groundwater <br />© Other Compliance Conditions (Compliance Component #3) -- Failing to protect groundwater <br />N Soil Separation (Compliance Component #4) — Failing to protect groundwater <br />❑ Operating permiVrnonitoring plan requirements (Compliance Component #5) — Noncomnliant <br />Property Information <br />Parcel Ito# or Sec/Twp/Range: <br />Property address: 1145 Wyndmere Road - Orono <br />Property owner: Steve Gill <br />or <br />Owner's representative: <br />Local regulatory authority: City <br />Reason for inspection; Sale <br />Owners phone: 952-258-0470 <br />Representative phone: _ <br />Regulatory authority phone: _ <br />Brief system description: 1250 & I-000 septic with a 1250 pump tank - elevated split rock trench drainfield <br />Comments or recommendations: - - <br />Top drop box on one of the drainflelds is broken <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: Josh Swedlund Certification number: C1659 <br />Business name: Swedlurid Septic Se ' e License number, 2502 <br />Inspector signature; L _ Phone number; 952.873-3292 <br />Necessary or 1-61ly Required Attachments <br />® Soil boring logs IT System/As-built drawing ® Forms per local ordinance <br />❑ Other informatlon (list): <br />WWW. pca.state. mn.us . 651-296.6300 . 800.657.3864 TTY 651.282.5332 or 800-657 <br />wq-wwists4-31 - 3116112 3864 Available in altemdCiwe formats <br />Page t of 3 <br />