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Jun 28 2015 10:13AM HP FaxRusty Olson 7634988290 page 2 <br /> Minnesota Pollution <br /> Control Agency Compliance Inspection Form <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems <br /> St.Paul,MN 55155-4194 (SETS) <br /> Doc Type:Compliance and Enforcement <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local mtrackiRQ�ase`:,ED <br /> requirements and attached forms-additional local requirements may also apply. E•��++CC��YY <br /> Submit completed form to Local Unit of Government(LUG)and system owner JUN 2 9 <br /> within IS days 2015 <br /> System Status <br /> CITY OF ORONO <br /> System stators on data(mm/ddlyyyy): 6124/2015 <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 04)—Failing to protect groundwater <br /> ❑Operating permit/monitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or SeclTwp/Range: 3311823320001 <br /> Property address: 1180 Townline Road., Orono, MN Reason for inspection: _ Property Transfer <br /> Property owner. Michael Theis Estate Owner's phone: <br /> or <br /> Owner's representative: Rick Brame Representative phone: 952-233-0125 <br /> Local regulatory authority: Citi of Orono Regulatory authority phone: 952-249-4600 <br /> Brief system description: 2-1000 gallon septic tanks and approArnately 350 square feet of trench per city records <br /> Comments or recommendations: <br /> The system must be replace. <br /> Certification <br /> I 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: Rus OIs Soil&Perc.Testing License number: 810 <br /> Inspector signature: Phone number: 763-498-8779 <br /> Necessary or ocally Required Attachments <br /> ®Soil boring logs ®System/As-built drawing ❑ Forms per local ordinance <br /> ❑Other information(list): <br /> www.pca.state.mn.us . 651-296-6300 • 800-657.3864 TTY 651-282.5332 or 800-657-3w • Available in alternative formats <br /> wq-wwfsts4-31 • 1124112 Page 1 of 3 <br />