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Sep 02 09 08:14p Joseph Oleon 763498�60 p.5 <br /> , • <br /> Parcel number. __�,,, Sy�tem statu.s: �Compliant ❑Noncompliant <br /> (as detemained by U�is fonr►) <br /> Soil Separation Con�pliance and Other Cotnplian�ce <br /> Compliance Issue #3 of 4 <br /> Date of observstion: 9�01103 Re�ason for observation: Pro�erty Transfer <br /> '�his rnfarmaban on f/�s fom�does r�ot expi�e. <br /> Compliance questions/criteria:(Required) Yeriflcation Method*•: (Optionat) <br /> .....(Ch°.ck tho�priofe AoJ (Chec/c mo appropriab box) <br /> For sys�oms built prior to April 1, 1996,and not � Conducted saI obe�ervat�on(s)(aitarh boring logs) <br /> tocated in Shoreland or Wdlhead Protsction <br /> Ar�a or not serving a food,beverage or ❑ Two previous vedications(attach bpring Iogs) <br /> Iodging establishmen� ❑ Other: <br /> Does the syst�n hava at laast a two-foot '���� <br /> veKica!separdtion distanoe fr+orr�periodieetly --. ...,.----- <br /> sat,urat�d soil or bedrocKt Yes No <br /> For non-peiiormanoe systvms built Apri19, <br /> 1986.or la�et or for non-performance spstems : .—. _.-...,,_._ <br /> bcaied i�Shcreland or iNeAhead Protection i Soil observativn doos not o�ire.P�evious observations <br /> Areas or serving a food,be�ver�qe or lodging I bY two independent perlies are sufficient.unless site <br /> establishment: conditions ha��e been albered. <br /> Ooes ihe system have a three-ioot v�artical <br /> separation distanoe irom periodically saturaDed <br /> soil or bedrock?' __„ _ Yes (� No <br /> Fo►reduced seperation distsnce systems(i.e.. <br /> "pe�farnance systems under old 7080.0179 cr " May be nad�rced by up tp 15 percer►t if allowed in loca! <br /> Type IV or V system under new 708Q.2350 or ordinence_ <br /> 70S02a00): ^No st�ndar+o�protacd exisfs. Thi�list is not exheustive, <br /> Does the system meel the dosigned vertical in seqvenlFel arrler, nw does it indreate whrch <br /> separation dsbance from periodicaNy saturated combinotivns are riecessary to meke this <br /> soil ot bedtodc?" .�.,...._ Yes No�. dete»�i�ation. <br /> Any'Mo"'answer MdiraGes tt,at d�e sysdwn/s taJ/�ng te proosct <br /> ground w�l�er: <br /> C@ft7flCa�l0�1 <br /> TAis fotm is ta be oomplelod a�d attached Oo tAe Surr�mery Form of the Minnesota Pollution Cortvd Agency's(MPCA)Compliance <br /> Inspectlorf Form fo�a[isting Subsurfat�e Svwage Tr+eqtrnent Syatems.ODservations,interprebtbns,and oonclusions must be <br /> completed by an inspedor or designer.Compl�ted form must be submitted to the(ocal unii af government within 15 days. <br /> Property ovv�ner name(s): Todd&Amy Hartman ____,..._ ,.,... <br /> ProPerty address: 60 MYrllewood Rasd�Orono,MN 55391 - , <br /> PropeRy ovmers eddress(A aineronq: _..._..,.. �_., �... <br /> County: Henneqin _,_� Phona: 6;12�518-2281 _ __ <br /> 1 hereby ce�ldy thet!pe�onalfy mt+de the obseNations,int�eip�eta�o�ns.an�d oorrc{�sions reparl�d on lhis 1�Ov►n end thet fhey sra <br /> covrnCt. <br /> Name_ ,Joseph J,Olson _„�_ CeRificaCion number_ 1255 y_ � . <br /> Business license name and rwmber, Rust�r Olsoh's soil arrd pernulsdon testiny L.io�810 �,_ or <br /> Name af locc�l unit vemment Ciry of Orono .�,� ^....._..-- <br /> Signabu ' . ..,. ... .... Da�te: 9/01/�9 <br /> vwq-wwists�-31 Compliance/nspection Forn►fw Existing SSTS <br /> 4/4/OS <br />