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Nov 12 2015 0924PM HP FaxRusty Olson 7634988290 page 2 <br /> Minnesota Pollution Cornpliance Inspection Form <br /> Contral Agency <br /> 520LafayetteRoadNorth Existing Subsurface Sewage Treatment Systems <br /> 5t.Paul,MN 55155-4144 ($$T$� <br /> Doc Type:Compliance and Enforcement <br /> Instructions: lnspection results based on Minnesota Pollution Control Agency(MPCA} For local tr e � I <br /> requirements and attached forms-additional local requirements may also apply. , 'I <br /> Submit complated form to Local Unit of Government(LUG)and system owner II r��� � �. 20�5 <br /> within 15 days <br /> CITY OF ORON <br /> System Status <br /> System status on date(mmlddlyyyy): 1 pl23/2015 <br /> � Compliant- Certificate of Compliance ❑ Noncompliant-Notice of Noncompliance <br /> (Valid(or 3 years from report date, unless sf�orter time (See Upgrade Requirements on page 3) <br /> frame ouflined in Loca!Ordinance.) <br /> Reason(s) for noncompliance (check a!l app/icableJ <br /> ❑ Impact on Public Health (Compliance Component #1)—lmminent threaf to public healfh and safety <br /> ❑Other Compliance Conditions(Complrance Component#3)—lmminent threaf to public health and safety <br /> ❑Tank Integriry(Compliance Componenf #2)—FaiJrng to protecf groundwater <br /> ❑ Other Compliance Conditions(Compliance Component#3)—Failing to profect groundwafer <br /> ❑Soil Separation(Complrance Component #4)—Failing to protect groundwater <br /> ❑Operating permiUmonitoring plan requirements(Compliance Componenl #5)—Noncomplianf <br /> Property Information ?arcel ID#or SeclTwplRange: 0411723230030 <br /> Property address: 2995 Deer Run Trail, Orono, MN_ Reason for inspection: Property Transfer <br /> Property owner. _Steve HiCks __ Owner's phone: 612-616-7323 <br /> or � <br /> Owners representative: Representative phone: <br /> Local regulatory authority: City of Qrono Regulatory authority phone: 952-249-46Q0 <br /> 1-1250 and 1-1000 gallon septictanks,l-1250 gallon lift station and 630 square feet of mound rockbed. <br /> Brief system description: per city records <br /> Comments or recommendations: <br /> Certification <br /> 1 here6y cerfify that al!the necessary information has besn gathered to derermine the compliance stafus of this system. 11l0 <br /> determination of(uture system performance has been nor can be made due to unknown conditions dunng system consfruction, <br /> possiWe abuse ol the system,inadequate maintenance, orfuture waterusage. <br /> Inspector name: Joseph J Olson __ Certification number: 1255 <br /> Business name: Rusty Ols n's Soil&Perc.Testin License number: 810 <br /> Inspector signature _ _ Phone number: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> � Soil boring logs � SystemlAs-built drawing ❑ Forms per local ordinance <br /> ❑Other information (list): <br /> www.pca.state.mn.us • b51-296-6300 . B00-657-3864 • TTY 651-282•5332 or 500-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • fJ24112 Paye t of 3 <br />