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Nov 11 2016 09:10AM HP FaxRusty Olson 7634988290 page 11 <br /> Minnesata Pol�ution Compliance I nspection Form <br /> Contral Agency <br /> 520 l.afayeae Road North Existing Subsurfa�e Sewage Treatment Systems <br /> SL Pauf,MN 55155-419d ($$TS) <br /> Doc Type�Compliance erxi Entorcemenl <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) �! Forr�o�a�t�acking purposes: i <br /> requirements and attached forms-additional local requirements may also apply. RECE�VE� <br /> Submit completed form to Local Unit of Government(LUG)and system owner ', � <br /> within 15 days I <br /> System Status CITY OF ORONO <br /> System status on date(mmlddlyyyy): 10120l2016 <br /> � Compliant-Certificate of Compliance ❑ Noncompliant- Notice of Noncompliance <br /> (Valid for 3 years from reporf date, unless shorter time (See Up.qrade Requirements on page 3) <br /> frame outlined in Local Ordinance.) <br /> Reason(s)for noncompliance(check all applicable) <br /> ❑ �mpacf on Public Health (Compliance Component #9)-lmminent threat to public health and satery <br /> ❑ Other Compliance Conditions (Compliance Component#3)-lmminent threat to pubJrC health and safety <br /> ❑Tank Integrity(Compliance Component ii2J-Failing fo protecf groundwafer <br /> ❑ Other Gompliance Conditions (Compliance Componenf#3)-FaiGng to protect groundwater <br /> ❑ Soii Separation (Complrance Cornponent #4)-Failing to protect groundwater <br /> ❑Operating permiUmonitoring plan requirements(Compliance Component #5)-lVonCompJiant <br /> Property Information Parcel iD#or Seclfwp/Range: _1 0 1 1 72 3240002 <br /> Property adcress 1Q45 Brown Road S., Orono, MN Reason for nspedion= Property Transfer <br /> Property owner: Eric Timko Owner's phone: 763-772-2259 <br /> or -- <br /> Owner's representative: Representative phone: <br /> Local regulaiory authority: City of Orono Regulatory authority phone: 952-249-4600 <br /> Approximately 2-1500 gallon septic tanks,'1-1500 gallon lift siation and 630 square feet of mound <br /> 8rief system description: rockbed. <br /> Comments or recommendations: <br /> Certification <br /> I hereby certi(y fhat al!the necessary rnforntafion has been gathered to determrne the complrance sfatus of this system. No <br /> determrnation�f future system performance has been norcan 6e made due fo unknown conditions during system construction, <br /> possible abuse ot the system, inadequafe maintenance, or(uture water usage. <br /> Inspectorname: _Joseph J Olson _ Certificaiion number: 1255 <br /> Business name: Rust 0 's Soil&Perc.Testin License number: 810 <br /> Inspectorsignature� Phone number: 763-498-6779 <br /> Necessary or Lacally Required Attachrnents <br /> � Soil baring logs �System/As-built drawing ❑ Forms per local ordinance <br /> ❑ Other information (list); <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282•5332 or 800-657-3864 • Available in alternacive formats <br /> wq-wwists4-31 • i114/12 Page 1 of 3 <br />