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Jul 28 2016 10:OOPM HP FaxRusty Olson 7634988290 page 2 <br /> � Minnesota Pollution Corn liance Ins ection Form <br /> Central Agency p P <br /> 52o Lafayette Road North Existing SubsurFace Sewage Treatment Systems <br /> St.Paui,MN 55155-4194 �ggTg� <br /> Doc Type:CompGance and Enfo�cement <br /> Instructions: Inspedion resu!ts based on Minnesota Paliution Control Agency(MPCA) ; For local trac ing purposes� <br /> requirements and attached forms—additional local requirements may also apply. � <br /> Submit completed form to Local Unit of Govemment(LUG)and system owner JUL 2 9 2016 �I <br /> within 15 days <br /> $ySt@ITl $tdtUS <br /> System status on date(mmlddJyyyy): 7/8/2016 <br /> � Compliant-Certificate of Compliance [� Noncompliant-Notice of Noncdmpliance <br /> (Valyd fo�3 years from report date, unless shorter time (See Upgrade Requiraments on page 3J <br /> frame ouflined in Loca!Ordinance.) <br /> Reason(s} for noncompliance(check a!!applicable) <br /> ] Impact on Public Healih (Compliance Component #1)—lmmrnent threat to publrc heafth and safety <br /> ;]Other Compliance Conditions (Compliance Component#3J—Irnminent thr�at to public heaJth and safety <br /> ❑ Tank Integrity(Compfiance Component #2)—Failing to protectgroundwater <br /> ❑ Other Compliance Conditions (Compliance Com�Oonent#3)—Failing to protecf g�vundwater <br /> ❑ Soil Separation (Compliance Componenf #4)—Failing to protect groundwater <br /> ❑ Operating permiUmonitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or SeclTwplRange: 041172331Q017 <br /> Property address: 294D Fox Street Orono, MN Reason for inspection: Property Transfer <br /> Property owner: David Meins �wner's phone: <br /> or __----__ <br /> Owner's representative: meredith Howell _ Representative phone: 952-476-3692 <br /> Local regulatory authority: Cfty of Orono Regufatory authority phone: 952-24�46Q0 <br /> Brief system description: 2-1300 and 1-1300 qallon lifl staEion and 680 square feet of mound rockbed. per ciry records <br /> Comments or recommendations: <br /> Certification <br /> 1 her�by certify that al!fhe necessary information has been gathered to deterrrrine the compliance stahls of this system, No <br /> defe�rnination of l�fure system perforrnance has been nor can be rnade d�e to unknown cond'rtions dunng system construction, <br /> possr6le abuse ofthe sysfem,inadequate mainfenance, orfuture waterusage. <br /> Inspector name: Joseph J Olson ___ Certification number: 1255 <br /> Business name: Rus Olson's Soil&Perc.Testln License number: 810 <br /> Inspector signatur�.-•-�--- �---- _ Phone number: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> � Soil boring logs �SystemlAs-built drawing ❑ Forms per local ordinance <br /> ❑ Other inforrnation (list); <br /> www,pca.state.mn.us . 651-296-6300 • 800-657-3854 • TTY 651-282•5332 or B00•657-3864 . A�ailable in altemative formats <br /> wq-wwists4•31 � 1/24/i2 Page 7 of 3 <br />