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Apr 29 14 10:41 a Joseph Olson 763-498-8290 p.2 <br /> Minnesota Pollution Compliance Inspection Form <br /> Corttrol Agency <br /> 520 La#ayette Road North Existing Subsurfaca Sewage Treatment Systems <br /> St.Pau1,Mf�55155-4i 94 4$$T5� <br /> Doc Type:Compliance and Enforoement <br /> Instructions: InspecBon resulis based on Minnesota Pollution Control Agency(MPCA) �Fp��ocal tracking purposes: <br /> requirements and attached forms—additional local requiremenEs may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owrter <br /> within 15 days <br /> S)/S�@iY1 $�cltl3S <br /> System status on date(mmlddlyyyyJ: 4/21114 <br /> ❑ Compliant-Certificate o#Co�pliance � Noncompliant-Notice of Noncompliance <br /> (Valid for 3 years friam repo�t date, unless shorter time (See Upgrade Requiremenfs on page 3) <br /> frame ouilined in Loca!Ordinance_J <br /> Reason(s)for noncompliance(check all applicable) <br /> � Impact on Public Health(Compliance Component #1)—lmminent threat fo public heafth and safety <br /> ❑Other Campliance Conditions{Gompliance Component#3)—lmminenf threat to pubfic healfh and safety <br /> ❑Tank integrity{Compliance Component #2}—FaiGng to protect groundwater <br /> ❑ Other Compliance Conditions(Compliance Component#3J—Failrng to protect groundwater <br /> ❑ Soil Separalion(Complia��ce Component #4)—Failing to protect graundwater <br /> ❑ Operating permiVmoniforing plan requirements (Compliance Comppnent #5}—NoncompJiant <br /> Property Information Parcel ib#or Sec�f"wplRange: 0511723230012 <br /> Property adc�ress: 3535 Christine Drive, Orono, MN Reason for inspection: Property Transfer <br /> Property owner: Robert Ryan Owner's phone: 612-8892212 <br /> or <br /> Owner's representative: RepresentaUve phone: <br /> Local regulatory aulhonty: Ciiy of Orono Regu3atory authority phone= 952-249-460Q <br /> 2-3 D00 gallon septic tanks,1-1000 gallon iift station and approximately 500 square feet of mound <br /> 8rief system description: rockbed.per ciry records <br /> Comments or recommendations: <br /> CQFt1�1Cat1011 <br /> !herehy certify that all the necessary informafion has been gathered to deteirr�ine tf�e compliance status of thrs system.No <br /> deferminafion of future system performance has been nor can be made due fo unknown conditions during sysfem construction, <br /> possrble abuse of fhe system,inadequate maintenance, or future water usage. <br /> Inspecior narne; Joseph J Olson Gertification number: 3255 <br /> Bvsiness name: Rusty Olson's Soil 8�Perc_Testing License number: 81D <br /> -- -.. . <br /> Inspector signature: __ �``� Phone number: 763-498-8779 <br /> Necessary or LocaUy Required Attachments <br /> ❑ Soil boring logs �System/As-buili drawing ❑ Forms per local ordinance <br /> ❑ Other information(list)' � <br /> www.pcastate.ma.us • 651-296-6300 - 800-657-3864 • TTY 651-28Z-5332 or 800•657-3864 • Available in attemative formats <br /> wq-wwists4-3i • il14/1Z Page ?of 3 <br />