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Mar 17 2017 09:55AM HP FaxRusty Olson 7634988290 page 2 <br /> ::.r Minnesota Pollution Compliance Inspection Form <br /> Control Agency <br /> 520 l.�fayette Road North Existing Subsurface Sewage Treatmer�t Systems <br /> St.Paul,MN 55155-4194 (BSTS� <br /> Doc Type:CompBenas and EMor�emeni <br /> Instructions: Inspecti�n resulis based on Minnesota Pollution Cor�trol Agency(MPCA) � For local tracking� <br /> requirert�nts and attached forms—additional local requirements may also apply. � <br /> Submit comple�ed form to Local Unit of C3overnment(LUG)and system owner � MAR 1 7 2011 <br /> within 1 S days <br /> C�TY OF ORONO <br /> Systern Status <br /> System status on date(mmlddfyyyy): 3/10/2017 <br /> Q�Compliant- Certi�cate of Compliance ❑ Noncompliant-Notice of Noncom pliance <br /> (Val'rd for 3 yesrs hnm repoR date,unless shorter Nme (See Upgrade Requirements on page 3) <br /> frame outlined in Loca!Ordfnanoe.) <br /> Reason(s)for noncomplia nce(ch�ck aq appllcable) <br /> ❑Impact on Public Health(Compliance Component #1)-lmminenf threat to public healih and safety <br /> ❑Other Compliance Conditions(Compliance Component#3)—lmminent threat to public health and safefy <br /> ❑Tank Integrity(Compliance Component #2)—Faifing to protect groundwafer <br /> ❑Other Compliance Conditions(Compliance ComponeRt�i.3}—Farling fo protect groundwater <br /> ❑Soil Separation(Compliance Component #4)—Failirrg to protect groundwafer <br /> ❑Operating permithnonitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or Seclfwp/Range: 27'1182333Q014 <br /> Property address: _1003 Cox Farm Road,Orono,MN Reason for inspection: Property Transfer <br /> Property owner: Daniel Hartlein Owner's phone: <br /> or <br /> Owners representative: Erik Myhran Represenfative phone: 812-810-3745 <br /> LoCal regulatory authority: City of Qrono Regulatory authority phone: 952-249-460Q <br /> 2-1000 gallon septic fianks,l-1000 gallon lift station and 500 square feet of mound rockbed.per Gty <br /> Brief system description: records <br /> Comme�ts or recommendations: <br /> There is a large number of trees growing through the mound system.The trees must to be removed or they will destroy the system. <br /> Certification <br /> 1 hereby certify that al!the necessary irrformafron has 6een gathered to determine the comp/iance status of this system.No <br /> determination of Tuture sysfem perfamance has been rror can be made due lo unknowrt condifions dudng system consfn�ction, <br /> possible a6use of the sysfem,inadequate maintenance, or future water usage. <br /> Inspector name: Jose h J Olson Cert�cabon number: 1255 <br /> Business name: Rus O 's Soil&Perc.Testin License number: 810 <br /> Inspedor signature: Phone number: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> �Soil boring logs �System/As-buiH drawing ❑ Fornns per local ordinance <br /> ❑Other informatiort(list): <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651•282-5332 or 800-657-3864 . Available in altemative formats <br /> wq-wwlsts4-3r . f/z4/f2 Poge 1 of 3 <br />