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' Minnesota Pollution Control Agency Compliance Inspection Form 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155-4194 Doc Type:Ccmpliance and Enforcement Inspection results based on Minnesota Pollution Control Agency(MPCA) For local traRD requirements and attached forms—additional local requirements may also apply. • Submit completed form to Local Unit of Government(LUG)and system owner MAY 2 6 2015 • within 15 days CITY OF ORONO System Status System status on date(mm/dd/yyyy): 5/25/2015 ® 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 Compliance Conditions(Compliance Component#3)—Imminent threat to public health and safety 0 Tank Integrity(Compliance Component#2)—Failing to protect groundwater El 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: 3211723230009 Property address: 460-Orchad Park Dr., Orono, Minn Reason for inspection: selling Property owner: Bob Rohden Owner's phone: or Owner's representative: Representative phone: Local regulatory authority: City of Orono Regulatory authority phone: . 2-1000 gallon septic tanks,1-1000 gallon pumping tank; Mound System 35 ft.wide by 80 ft.long Rock bed 10 ft.wide by 55 ft. long Brief system description: Comments or recommendations: 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. 1 Inspector name: Robert A. Koch _ Certification number: 1429/ Business name: Koch!s Soil'Testing / --- License number: 193 .r ------- Inspector signature: *(o L, Phone number: 763-479-2637 Necessary or Locally Required Attachments ® Soil boring logs 0 System/As-built drawing 0 Forms per local ordinance A e 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 • 3/16/12 Page 1 of 4