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Apr 20 15 06:16p Joseph Olson 763-498-8290 p.2 <br /> � � <br /> � <br /> Minnesota �oilution Compliance Inspection �orm <br /> Con�rol Agency <br /> 520LafayetteRoadNorch Existing Subsurface Sewage Treatment Systems <br /> St Paui,MN 55155-4194 (SSTS� <br /> Doc Type:Compliance and Enfor�ement <br /> .L+-�.J 11.. <br /> Instructions: Inspection resul[s based on Minnesota Pollution Contro!Agency(MPCA) For local iracking purposes: <br /> requiremenls and attached forms—additio�a!local requirements may also apply. APR � � �0�� <br /> Submit completed Eorm to Local Unit of Government(LUG)and system owner <br /> within 15 days � � <br /> � <br /> System Status <br /> System status on date�mm/ddlyyyy): 4l16/2015 <br /> � Compliant- Certificate of Cornpliance ❑ Noncompliant-Notice of Noncompliance <br /> (Valyd for 3 years from report date, unless shorter lime (See Upgrade Regurrements on page 3) <br /> f�ame outlrned in Loca1 Ordinance.) <br /> Reason{s)for noncompliance (check all applicab/e) <br /> ❑ Impact on F'ublic Health(Compl+ance Component #1)—Jmminenf tfireat to pu6lic healfh and safety <br /> ❑ Otfief Compliance Conditions(Compliance Component#3)—lmminenf threaf fu public health and safety <br /> ❑Tank Integrity (Compliance Componenf #2)—Failing to protectgroundwater <br /> ❑Other Compliance Conditions(Compl;ance Component#3)—Fail;ng to protect groundwater <br /> ❑Soil Separation (Compliance Cornponent #9)—Farfing to protect gmunclwater <br /> ❑Operating permiUmonitoring plan requirements(Compliance Component #5}—Noncompliant <br /> Property Infvrmation Parcel ID#or SeclTwplRange: 31'f 1823110009 <br /> Property address: 755 Hunt Farm Road, Orono, MN Reason for inspection: Property Transfer <br /> Property owner: _Timothy Admonius __�� Owner's phoRe: 612-325-5731 <br /> or - <br /> Owne�'s representaiive: _ Representaiive phone: <br /> Local regulatory a�thonty: City of Orono Regulatory auihority phone: 952-249-4600 <br /> 2-100Q gallon septic tanks,1-1000 gallon IifE station and 500 square feet of mound roc3cbed. per city <br /> Brief system description: recards <br /> --. __ .. <br /> Commen;s or recornmendations <br /> Certification <br /> !hereby cerfify thaf a!l the necessary infoimabon has been gathered to determine the compliance stafus of ihis system. IUo <br /> deterrninaGon of futur�system perfonnance has been nor can be made due to unknown condifions dunng sysfem constrr�ction, <br /> passible abuse of(he sysfem,inadequate mainienance, or future water usage_ <br /> InspeGor name: Joseph J Olson Certification numb�r: 1255 <br /> Business r,ame: Rusty Olson's Soil 8, Perc.Testing License Rumber: 810 <br /> Inspector signature� Phone number: 763-498�779 <br /> Necessary or Localty Required Attachments <br /> �Soil boring logs �SystemlAs-b�ift drawing ❑ Forms per local ordinance <br /> ❑Other inforrnation(list): <br /> wwtiv.pca.state.mn.us � G51-246-6300 • 800-657-38b4 • T7Y 651-ZSZ-5332 or 500-657-3864 • Available in altemative formats <br /> wq-wwists4•3i • i124/12 Page 1 oj3 <br />