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May 22 13 08:55a Joseph Olson 763-498-8290 p.2 <br /> • Y. <br /> Minnesota Pollution /Ir <br /> Control Agency } Compliance Inspection Form <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems <br /> St Paul,MN 55155-4194 (SSTS) <br /> Doc Type,-Compliance and Enforcement <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <br /> requirements and attached forms—additional local requirements may also apply. i <br /> Submit completed form to Local Unit of Government(LUG)and system owner <br /> within 15 days L <br /> System Status <br /> System status on date(mmiddlyyyy): 5/20/2013 <br /> ® Compliant—Certificate of Compliance ❑ Noncompliant—Notice of Noncompliance <br /> (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3) <br /> frame outlined in Local Ordinance.) <br /> Reason(s)for noncompliance(check all applicable) <br /> ❑ Impact on Public Health (Compliance Component #1)—Imminent threat to public health and safety <br /> ❑Other Compliance Conditions(Compliance Component#3)—Imminent threat to public health and safety <br /> ❑Tank Integrity(Compliance Component #2)—Failing to protect groundwater <br /> ❑Other Compliance Conditions(Compliance Component#3)—Failing to protect groundwater <br /> ❑ Soil Separation(Compliance Component #4)—Failing to protect groundwater <br /> ❑ Operating permittmonitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: 04-117-23-11-0018 <br /> Property address: 2425 Throughbred Lane, Orono,MN Reason for inspection: Property Transfer _ <br /> Property owner: Paul Dejute Owner's phone: 952-404-1144 <br /> or <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: City of Orono Regulatory authority phone. 952-249-4600 <br /> 2-1300 gallon septic tanks,1-1300 gallon lift station and 680 square feet of mound rockbed. per city <br /> Nef system description: records <br /> Comments or recommendations: <br /> ,)tThe edsting iron filter must be plumbed out of the septic system. <br /> Certification <br /> f hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No <br /> determination of future system performance has been nor can be made due to unknown conditions during system construction, <br /> possible abuse of the system,inadequate maintenance, or future water usage. <br /> inspector name: Joseph J Olson Certification number: 1255 <br /> Business name: Rust on's Soil &Perc.Testing License number 810 <br /> Inspector signature- Phone number: 763-498-8779 <br /> Necessary or Locally Required Attachments <br /> ®Soil boring logs ® System/As-built drawing ❑ Forms per local ordinance <br /> ❑Other information (fist): <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 TTY 651.282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • 1124112 Page f of 3 <br />