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Aug 28 2015 09:18AM HP FaxRusty Olson 7634988290 page 2 <br /> <<.. <br /> �� Minnesota Pollution Compliance Inspection Form <br /> Contral Agency <br /> 520LafayetteRoadNorth Existing Subsurface Sewage Treatment Systems <br /> St.Paui,MN 55155-4194 ($$'r$) <br /> Coc Type:Complisnce and Enforcement <br /> Instructions: Inspection resuNs based on Minnesota Pollution Control Agency(MPCA) I, For Iocal tracking purposes: � <br /> requiremeMs and attached fonns—additional local requiremerts may also apply. j I <br /> � �ECEIVE� � <br /> Submit completed form to Local Unit of Government(LUG)and system owner <br /> within 15 days ' � <br /> ��t� <br /> 5ystem Status CITY OF ORONO <br /> System status on date(mmlddlyyyy): 8l24/2015 <br /> � Compliant— Certificate of Compliance ['j Nancompliant—Notice of Noncompliance <br /> (Valid fo�3 years from repon date, unless shorter time (See Upgrade Requrremenfs o»page 3) <br /> frame outlined in Local Ordinance.) <br /> Reason(s)for noncompliance(check al!applicable) <br /> ❑ Impact on Puqlic Health (Compliance Component #1)—Imminent fhreat to public health and safety <br /> ❑ Other Compliance Conditions (Compliance Component#3)—Imminenf threat to public health and safety <br /> ❑Tank Integrity(Compliance Component #2)—Farlrng to protect graundwater <br /> ❑ Other Compliance Conditions(Campliance Component#3)—Failing to protect groundwater <br /> ❑ 5oil Separation (CompJiance Component #4)—Failing to protect groundwater <br /> ❑Operating permiUmonitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or SecfTwp/Range: 36'11823120014 <br /> Propery address: 795 Ferndaie Road N, Orono, MN __ Reason for inspection: Property Transfer <br /> Property owner: _fred Strobl Owne�'s ph�ne: 952-473-1966 <br /> or � <br /> Owner's representative: _ _ __� Representative phone: <br /> Local regulatory authority: Ci of Qrono _ _ Regulatory authoriiy phone: 952-249-4600 � <br /> 2-1000 gallon septic tanks,l-10Q0 gallon lift station and 500 square feet of mound rockbed. per city <br /> Brief system description: records <br /> Comments or recommendations: <br /> The dead patch of grass was caused by lawn service.As per owner <br /> Certification <br /> J hereby cerfify thaf alJ the necessary r'nlorrnation has been gathered to determine the compliance status of this system. No <br /> determina!ion of future system perforr»ance i�as been norcan 6e made due to unknown conditions dunng system constructior�, <br /> possible abuse of fhe sysfem,inadequate rnaintenance, or future water usage. <br /> Inspector name: Joseph J Olson_ Certification number: 1255 <br /> Business name: Rust on's Soil& Perc,Testing _ License number: 810 <br /> Inspector signature: _ _ Phone number: 763-498-8779 <br /> Necessary or Locally Requ9red Attachments <br /> � Soil bor'ng logs �System/As-built drawing ❑ Forms per local ordinance <br /> ❑ Other information (list): <br /> www.ptastate.mn.us • 651-296-630U • B00•657-3864 . TTY 651•282•5332 or 800-657-3864 • Avaitahle in altemative formats <br /> wq-wwists4-31 . 1/24lt� Paqe 1 of 3 <br />