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Nov 12 2015 09:26PM HP FaxRusty Olson 7634988290 page 16 <br /> � � <br /> j <br /> �.�'� Minnesota Pollution ' <br /> Control Agency Com pl�ance I nspection Form <br /> 520 Lafayette Road North Existing Subsurtace Sewage Treatment Systems <br /> Sc.Paul,MN SS755-4194 (SST$� <br /> Doc Type:Compl�ence and Enforcement <br /> Instructions: Inspectian results based on Minnesota Pollution Controi Agency(MPCA) For local tracking�urpoEIVED <br /> requirements and attached forms-additional local requirements may also apply. REC <br /> Submit completed form to Lacal Unit of Government(LUG)and system awner ' <br /> within 15 days ' NOV � � 2Q�� I <br /> System Status CITY OF ORONO <br /> System staius on date(mm! lyyyy): 1Q/30l2015 <br /> � Cornpliant-Certifi ate of Complia ❑ Noncompliant- Notice of Noncompliance <br /> (Valid for 3 years fmm re rt dafe, unle orter time (See Upgrade Requirements on page 3J <br /> frame outlined in Local Orciin <br /> Reason(s)for noncompliance (check al!applicableJ <br /> ❑ Impact on Public Health (Compliance Component #1)-Imminent threat to public health and safety <br /> ❑ Other Compliance Conditions(Compliance Component#3j-Imminent threat fo public health and safety <br /> ❑Tank Integrity(Compliance Component #2)-Failing to protect qroundwater <br /> ❑Other Compliance Conditions(Cornpliance Component#3)-Failing to protect groundwater <br /> ❑ Soil Separation (Complisnce Component #4)-Failing to protect g�undwater <br /> ❑ Operating permiUmonitcring plan requirements(Compliance Componenf #5)-Noncompliant <br /> Property Information Parcel ID#or SeclTwp/Range: 0411723210011 <br /> Property address: 2990 Somerset Lane, Orono, MN Reason for inspection: Property Transfer <br /> Property owner: M.E. Bundy _ Owner's phone: <br /> or --- <br /> Owner's representative: Joe Cashrnore Representative phone: 612-695-8137 <br /> Local regulatory authority: City of Orono Regulatory authority phone: 952-249-46a0 <br /> 2-1300 gallon septic tanks,l-1300 gallon lifl station and 630 square feet of mound rockbed. per city � <br /> Brief system description: records <br /> Comments or recommendations: <br /> Certification <br /> I hereby certify that all fhe necessary information has been gathered to determine the comp/iance sfarus of this system. No <br /> determination of fvture system performance has been nor can be made due to unknown conditions dunng system constructron, <br /> possible abuse ofthe system,inadequate maintenance, or future water usage. <br /> Inspector name: Jose�h J Olson Certification number: 1255 <br /> Business name Rust Olson's Soil&Perc.Testin License number: 810 <br /> Inspector signature: Phone number: 763-498-8779 i <br /> Necessary Lacally Required Attachments <br /> � 5oil boring logs �System/As-built drawing ❑ Forms per local ardinance <br /> ❑ �ther information (list): <br /> www,pta.siace.mn.us . 651-246•63Q0 • B00-657-38b4 • TTY 651-282�5332 or 800-657•3864 • Available in alternative Formats <br /> wq-wwists4-31 • i/24l12 Page 1 af 3 <br />