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Jun 07 2016 07:47AM HP FaxRusty Olson 7634988290 page 2 <br /> Minnesota Pollution Compliance I nspection Form <br /> Control Agency <br /> 520 Lafayette Raad Narth Existing Subsurtace Sewage Treatment Systems <br /> Sc.Paul,MN 55155-4199 ($$T$) <br /> Doc Type:Compliance end Enforcement <br /> ---- —, <br /> Instructions: Inspection results based on Minnesofa Pollution Controi Agency(MPCA) For IoCaGt(�9.{xyrp�66S: � <br /> requirements and attached forms—additional local requirements may also apply. , r� ����" ' <br /> Submit compteted form to Local Unit ef Governrnent(WG�and system owner ' <br /> within 15 days �JUN O T �O�C I <br /> System Status CITY OF ORONO <br /> System status on date(mmldd/yyyy): 511612016 <br /> � Compliant-Certificate of Compliance ❑ Noncompliant- Notice of Noncompliance <br /> (Va/id for 3 years from report date, unless shorter trme (See Upgrade Requirements on page 3) <br /> frame outlined in Loca!Ordinance.J <br /> Reason(s)for noncompliance (check al!applicable} <br /> ❑ Impact on Public Healih (Comp(rance Component #1)—lmminenf threat to public health and safety <br /> ❑Other Compliance Conditions(Compliance Component#3)—lmminent fhreat to public health and safety <br /> ❑Tank Integrity(Comp/iance Component #2)—Failrng to protect groundwater <br /> ❑ Other Compliance Conditions(Compliance Componenf#3)—Failing to protect groundwater <br /> � Soil Separation (Compliance Component #4)—Failing to profect groundwater <br /> ] Operating permiUmonitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Infarmation Parcel ID#or SeCJTwplRange: 10-117-23-32-0012 <br /> Property address: 1260 French Creek.Circie.,Orono, MN Reason for inspection: Pro ert Transfer <br /> Property owner. Kadee Watkins Owner's phone: 612-810-5345 <br /> or <br /> Owner's represertative: Representative phone� <br /> Local regulatary authority: City oi Orono Regulatory authority phone: 952-249-4600 <br /> 2-1000 gallon septicianks,l-1000 gallon lift station and 500 square feet of mo�nd rockbed. per city <br /> Brief system description: records <br /> Comments or recommendations: <br /> Certification <br /> 1 hereby certify that a1l the necessary information has been gathered to determrne the compliance status of this system. No <br /> determrnafion of futur�system performance has been nor can be made due to unknawn conditions dunng system construcfion, <br /> possible abuse of the system,inadequate mairttenance, or future water usage. <br /> Inspector name, Joseph J Ofson Certification number: 1255 <br /> Business name: Rusty on's Soil&Perc.Testin License number: 810 <br /> Inspector signature: _ Phone nurnber: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> ;� Soil boring logs � System/As-built drawing ❑ Forms per local ordinance <br /> ❑ Other informaiion (list): <br /> www.p<a.state.mn.us . 651•296-6300 • 800-657-3664 • TTY 651-282-5332 or 800-657•3864 • Available in alternative forma[s <br /> wq-wwisis4-3P . 1/14/12 Page 1 of 3 <br />