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� <br /> Jun 1413 11:33a Joseph Olson �� 763-498-8290 p.2 <br /> t � <br /> � �, <br /> ' � N�innesota Pofiution � Compliance Inspection Form <br /> / .� <br /> � Control Agency �" <br /> 520 La#ayette Road North �/ Existing Subsurface Sewage Treatmenrt Systems <br /> St.Paut,MN 55155-4194 (S$TS) <br /> Doc Type:Compliance and Enfor�emerrt <br /> 4 <br /> Instructlons: Inspection results based on Minnesota Pollution Control Agency(MPCA} For local tracking purposes: � <br /> requirements and attached forrns—additional local requirements may also appiy. , <br /> Submit comp�etecf form to Local Unitof Government{LUGJ and system owner <br /> within 15 days <br /> S�/S�@t11 5�8tU5 <br /> System status on dafe(mmlddlyyyy): 6l13(2413 <br /> ❑ Compliant-Certificate of Compiia�ce � Noncompliant- Notice of Noneompliance <br /> (Valid for 3 years from r�port date, un(ess shorter frme (See Upgrade Requirements on page 3) <br /> franre outlined in Local Orrlinance.) <br /> Reasort(s)for noncompliance (check all applicable) <br /> ❑ lmpact on Public Heatth (Compliance Cvmponent #1)—/mminenl threat to public heaJth and safety <br /> ❑Other Compfiance Conditions(Compliance Component#3j—�mminent threat to public health and safety <br /> ❑Tank Integrity(Comp�iance Componenf #2)—Failrng to protect groundwafer <br /> ❑Other Compliance Conditions(Compliance Component#3)—Failing fo protect gmundwafer <br /> �SoiE Separation(Compliance Camponent #4)—Failing to pmtecf groundwater <br /> ❑Operating permit/monitoring pian requirements(Compliance Component #5J—Noncompliant <br /> Property Information Parcel IQ#orSec/Twp/Range: 1 1 1 1 723230a16 <br /> Property address: 1480 Green Trees Road ,Orono,MN Reasan for inspection: Property Transfer <br /> Property owner: Carl Platou _ Owner's phone: __ <br /> or <br /> pwne�'s representative: Johannes Marliem Representative phone: 6�2-839-3928 <br /> Local regulatory auihority: City of Orono Regulatory authority phone: 952-249-0600 <br /> Br+ef system description: 2-1000 qallon sepiic tanks and approximately 312 lineal feet of trench per city records <br /> Comments or recommendabons: <br /> Certification <br /> !hereby certify that a!!fhe necessary rnformatron has been gather�d fo deteRnrne tt�e compriance status of fhrs sysfem. No <br /> deterrrrrnafion of future system performance has been nor can be made due to unknown conditions during system constrvction, <br /> possibfe abuse offf�e sysfem,inadequate mainfenance, orfuture waterusage_ <br /> Inspector name: Joseph J Olson Certification number: 1255 _ <br /> Business name: Rust Olson's Soil 8.Perc.Testin License number: 810 <br /> Inspector signature: Phone number: 763-49&8779 <br /> Necessary or Locally Required Attachments <br /> �Soil boring logs �System/As-bui(t drawir�g ❑ Forms per local ordinance <br /> []Other information(list): <br /> wtvw.pca.state.mn.us • 651-296-6300 • 800-657-38b4 • TTY 65;-282-5332 or 80a657-3864 • Availab[e in altemative formats <br /> wy-wwists4-31 • 11.24!iZ Poge�of 3 <br />