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Aug 0512 08;08p Joseph Olson ��1 763-498-8290 p.2 <br /> � (. <br /> � � A�� <br /> Minnesota Pallution �' � !� ' Compliance Inspection Form <br /> Contro! Agency � � <br /> 520 lafayette Road M1lorth � � Ex�ting Su6surFace Sewage Treatr�tent Systerr�s <br /> 5t.Paul,M!V 5 51 5 5-41 94 (��\' k � � ��'� (SSTS� <br /> � ` ' r" /\ � Doc Type:CompGar►ce and Enfor�emenf <br /> v � Gj, <br /> Instructions: Inspection results based on Minnesola PoNution Comro€Agency(MPCA) � Far local tracking purposes: � <br /> requirements and attached forms—additional local requirements rnay also apply. � <br /> 5ubmit completed form to Local Unit oF Govemment(LUG�and sysbem owner � <br /> within 15 days ` <br /> System Status <br /> System status on dabe(mm/dd/yyyy): 7/30/2D12 <br /> � Compliant— Certifica#e of Compliance ❑ Noncompliant— t�otice of Noncornpliance <br /> (Valid for 3 years from report date, unJess shorfer 6me (See Upgrade Requi�ments on page 3) <br /> frame outJined in Loca1 Ordinance.) <br /> Reason(s)far rroncornpliance(check all applicab/e} <br /> ❑ Impact on Public Health{Compliance CompoRent #1)—Imminenf threat to pUblic health and safefy <br /> ❑ Oiher Compliance Conditions(Compliance Componenf�t3J—Imminent threat to pu6Jic health arrd safety <br /> ❑Ta�k Integrity{Cornpliance Component #2)—Failing ho protect grounduvate� <br /> ❑Other Compfiance Condilions(Compliance Componentil3)—Failing to protecf grr�undwrater <br /> ❑ Soil Sepa ration(Compliartce Component #4J—Failing fo protect groundwater <br /> ❑ Operating permiUmonitoring plan requirements(Complianc�e Component #5)—Noncomplianf <br /> Praperty Information Parcel ID#or SeclTwp/Range: 3311623330011 <br /> Property address: _170 Crystal Creek Road., Orono, MN Reason for inspection: Property TransFer <br /> Property owner: Larry Guzan Owners phone: 952-25a83S2 <br /> or <br /> Owne►'s representative_ Representative phone: <br /> Local iegulatory authority: City of Ororto Regufatory authority phone: 952-249-4800 <br /> 2-13Q0 gallon septic ianks,1-1300 gallon lift siation and 630 squa�e feet of mouncf rockbed.per aty <br /> Brief system description; recards <br /> Comments or recammendations: <br /> The existing mound sysle�has trees growing through it.The trees should be removed. <br /> Certification <br /> I hereby certiry that a!!the necessary rnformafion has 6een gathered to determine the comp/iance status of tf�is sysfem. No <br /> deferminab'on of future sysfem perlormance has been nor caR be made due to unknown condifions during system const�ction, <br /> possible abuse af the system,iriadequate maintenance, or fufum water usage. <br /> Inspector name: Joseph J O€son Certifcation number. 1255 <br /> Business name: Rusty Olson's Sai[8�Perc.Testing License number: 61 D <br /> Inspector signature�/�� — PF�one num6er_ 763�98-8779 <br /> � <br /> Necessary or Locally Required Attachrnents <br /> � Soil boring logs �System/As-built drawing 0 Forms per local ordinance <br /> Q Other information ¢ist): <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 - TTY 651-262-5332 or 800-657-3864 • Available in altemative formats <br /> V. .7ya�c�u�a�w��r�..v...w.�..��a�..�.��.. ........ �... ......., ......-'_-"-------•-�----- � --�- <br /> '`System is iailing to proteci groundwater r <br /> Explain: <br /> www.pca.state.mn.us • 651-296-630U • B00-657-3864 • 7TY 65t-282-5332 or 800-657-3864 • Available in afternative formats <br /> I <br /> I <br />