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� 2 of 9 ,�'� Minnesota Pollution �:: �ontralAgency Compliance Inspection Form � 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems St.Paul,MN 55155-4194 (SSTS� Doc Type:Compliance and Enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tra{�i�i�D requirements and attached forms—additional local requirements may also apply. �1 �� Submit completed form to Local Unit of Government(LUG)and system owner Aua o 3 20» within 15 days cmr oF oRONo System Status System status on date(mmldd/yyyy): 7127/2017 � Compliant-Certificate of Compliance ❑ Noncompliant- Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3) frame outlined in Local Ordinance.) Reason(s)for noncompliance (check all applicable) ❑ Impact on Public Health (Compliance Component #1)—Imminent threat to public health and safety ❑Other Compiiance Conditions (Compliance Component#3)—Imminent threat to public health and safety ❑Tank Integrity(Compliance Component #2)—Failing to protect groundwater ❑ Other Compliance Conditions (Compliance Component#3)—Failing to protect groundwater ❑Soil Separation (Compliance Component #4)—Failing to protect groundwater ❑Operating permit/monitoring plan requirements (Compliance Component #5)—Noncompliant Property Information Parcel ID#or Sec/Twp/Range: 25-118-23-43-0014 Property address: 315 Hollander Rd, Orono, MN 55391 Reason for inspection: Property Transfer Property owner: Roger&Elizabeth Fazendin Owner's phone: or Owner's representative: Structure Tech Representative phone: 952-915-6466 Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 Brief system description: Three pre-cast septic tanks,a pre-cast�ift tank,and a mound. Comments or recommendations: It should be noted that the effluent filter was plugged and was causing a high liquid level in the septic tanks. The filter should be cleaned and the filter alarm should be checked to see if it is working properly. Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Brian Humpal Certification number: L5342 Business name: Inspect Minnesota, Midwest Soil Testing License number: L2896 Inspector signature: ,�,o.,ti i��iG.�,.�,Q,Q Phone number: 651-492-7550 Necessary or Locally Required Attachments � Soil boring logs � System/As-built drawing ❑ Forms per local ordinance � Other information (list): Report Summary Property Information Disclaimer License www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 1/24/12 Page 1 of 3