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Apr 29 1411:13a Joseph Olson 763-498-8290 p.2 <br /> , <br /> Minnesota Roltutian Compliance Inspection Form <br /> Control Agency <br /> 520 Lafayette Ro�d North E�S��9 Subsarface Sewage Treatment Systems <br /> St.Paul,MN 55155-4'194. �SSTS� <br /> �oc Type:Compliance and E�eme�t <br /> Instructions: lnspection resutEs baged on Ntinnesota Pollu6�Control Agency(MPCA) For local trackmg purposes: <br /> requirements and attached forms—additional Ioc�requirements may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owner <br /> arithin 15 days <br /> System Status <br /> System status on date{mm/ddlyyyy): 2f25/2014 <br /> � Compliant-Certificate of Cor�pliartce ❑ Noncompliant-Notice of Noncompliance <br /> {Valid for3 yea►s frvm repwt date,unless shorterSme �See Upgrade Requi�ernents on page 3) <br /> fr�me outlirred in L�a!Ordinanc�e.J <br /> Reason(s)#or noncompliance(check af!applicab/e} <br /> ❑ Impact on Public Health(Compliance Component #1)—/rrtminent threat to public health and safety <br /> ❑Other Compliance Conditions(Compliance Componant�13)—Irrrminent threaf to puWic health snd safety <br /> ❑Tank Integrity(Compliance Componerrt #2)—Fail►ng to profect grtwndwater <br /> ❑ Other Compliance Conditions(Complranve Component�3)—Failing fo pmlect gr+oundwater <br /> ❑Soil Separa4ion(Complrance Component #4)—Failrng tr�protect groundwater <br /> ❑Operating permit/monitoring plan requiremerris(Compliance Component �5)—Noncompliarrt <br /> Property Information Parce►ID#or SeclTwp/Range: 3511823330010 <br /> Property address: 30 Or�o Orchard Road,Orono,MN Reasar�tor inspectian: Property Transfer <br /> Property awner: James Murphy Owners phone: <br /> or <br /> Owne�s representative: Gregg Hahn RepreseMative phone: 612-280-2341 <br /> Local regulatory aWhority: City of Orono _ Regulatory aut�ority phone: 952-249-460d <br /> Brief sysiem description: 2-1000 and 1-1Q00 gaflon lift station and 380 square feet of moun8 rockbed per city records <br /> Comments or recommendations: <br /> Certification <br /> !hereby certify that a!I the necessary irriorma�on has been gathered to determine the compliance status of thrs system.No <br /> detem�ination of futwe system perf+�rmarrce has been nor can be made due Eo unknown eonditions dunng system constnrction, <br /> possibla abuse of the system,inadequate mairrtenance, or future wafer usage. <br /> Inspector name: Joseph J ��son Certficatipn number: 1255 <br /> Business name: Rusty Olson's Soil 8�Perc. Testi�g License number. 814 <br /> lnspector signaWre:,�;�+'" Phone number 763-d98-8779 <br /> Necessary or Loraily Required Attachments <br /> �Soil boring logs �SystemlAs-buift drawing ❑ Forms per locaf ordinance <br /> ❑ Other infomiation(list): <br /> www.pca.sCate.mn.us • 651-296-6390 • &00-6b7•3864 • T7Y 651-282-5332 or 500-657-3864 • Available in altemative formats <br /> wq-wwfsts4-3f • 1/24/12 <br /> Page 1 of 3 <br />