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1 MINNESOTA POLLUTION Compliance ins ection report form <br />CONTROL AGENCY p <br />520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) <br />5t. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement <br />Instructions: Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of <br />final determination of compliance or noncompliance. Instructions for filling out this form are located on the Minnesota Pollution <br />Control Agency (MPCA) website at httos://www.pca.state.mn.us/sites/default/files/wa-wwists4-31a.pdf. <br />Property Information Local tracking number: <br />Parcel ID# or Sec/Twp/Range: 0311723230022 Reason for Inspection Property Transfer <br />Local regulatory authority info: _City Of Orono, (952) 249-4600 <br />Property address: 2325 Willow Hill Drive, Orono <br />Owner/representative: GreggLarsen Owner's phone: 612-810-5345 <br />Brief system description: 2-1300-gallon septic tanks, 1-1300-gallon lift station and 630 Square feet Rock bed <br />System status <br />System status on date (mm/dd/yyyy): 4/27/2023 <br />❑ Compliant — Certificate of compliance* <br />(Valid for 3 years from report date unless evidence of an <br />imminent threat to public health or safety requiring removal and <br />abatement under section 145A. 04, subdivision 8 is discovered or <br />a shorter time frame exists in Local Ordinance.) <br />*Note: Compliance indicates conformance with Minn. <br />R. 7080.1500 as of system status date above and does not <br />guarantee future performance. <br />® Noncompliant — Notice of noncompliance <br />Systems failing to protect ground water must be upgraded, replaced, or <br />use discontinued within the time required by local ordinance. <br />An imminent threat to public health and safety (ITPHS) must be <br />upgraded, replaced, or its use discontinued within ten months of receipt <br />of this notice or within a shorter period if required by local ordinance or <br />under section 145A.04 subdivision 8. <br />Reason(s) for noncompliance (check all applicable) <br />❑ Impact on public health (Compliance component #1) — Imminent threat to public health and safety <br />❑ Tank integrity (Compliance component #2) — Failing to protect groundwater <br />❑ Other Compliance Conditions (Compliance component #3) — Imminent threat to public health and safety <br />❑ Other Compliance Conditions (Compliance component #f3) — Failing to protect groundwater <br />❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) — Failing to protect groundwater <br />® Soil separation (Compliance component #5) — Failing to protect groundwater <br />❑ Operating permit/monitoring plan requirements (Compliance component #4) — Noncompliant - local ordinance applies <br />Comments or recommendations <br />The system is designed for a five bedroom house. <br />There is 1.0 feet of sand under the rock bed. <br />The system is not an Imminent threat to public health. The rock bed would need to be raised with sand approximately 12 inches <br />to be compliant.. <br />Certification <br />1 hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of <br />future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, <br />inadequate maintenance, or future water usage. <br />By typing my name below, 1 certify the above statements to be true and correct, to the best of my knowledge, and that this information can be <br />used for the purpose of processing this form. <br />Business name: Rusty Olson Soil & percolation Testing_ Certification number: C1255 <br />Inspector signature: Joseph J. Olson License number: L810 <br />(This document has been electronically signed) Phone: 763-498-8779 <br />Necessary or locally required supporting documentation (must be attached) <br />® Soil observation logs ® System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit <br />❑ Other information (list): <br />https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-wwists4-31b • 4/28/2021 Page 1 of 4 <br />