Laserfiche WebLink
Minnesota Pollution <br />Control Agency compliance Inspection Form <br />C <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 (MPCA) I 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): 10/29/2020 <br />Compliant - Certificate of Compliance <br />(Valid for 3 years from report date, unless shorter time <br />frame outlined in Local Ordinance.) <br />Reason(s) for noncompliance (check all applicable) <br />❑ Noncompliant — Notice of Noncompliance <br />(See Upgrade Requirements on page 3) <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 />I] 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 JD# or SeclTwp/Range: 3311823330003 <br />Property address: 75 Crystal Creek Road, Orono, MN Reason for inspection: Property Transfer <br />Property owner: _ Eric Larson — _ Owner's phone: 612-805-7288 <br />or <br />Owner's representative: Representative phone: <br />Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 <br />1-1250 and 1-1000 gallon septic tanks and 1-1250 gallon lift station and 630 square feet of mound <br />Brief system description: rockbed. per city records <br />Comments or recommendations: <br />TBM: Top of the lift station manhole cover. There is 1.2 Feet of sand under the rock bed. I drilled through the rock bed there is 0.6 <br />feet of rock <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 <br />Business name: Rusty Olsep's Soil & Perc. Testing <br />Inspector signature: r <br />Necessary or Locally Required Attachments <br />0 Soil boring logs ® System/As-built drawing <br />Other information (list): <br />www.pca.state.mn.us • 651-296-6300 . 800-657-3864 <br />wq-wwists4-31 • 1124112 <br />Certification number: 1255 <br />License number: 810 <br />Phone number: 763-498-8779 <br />❑ Forms per local ordinance <br />TTY 651-282-5332 or 800-657.3864 • Available in alternative formats <br />Page 1 of 3 <br />