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Nov 12 2015 09:25PM HP FaxRusty Olson 7634988290 page 9 <br /> Minnesota Pollution Compliance Inspection Form <br /> Control Agency <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 traCff D <br /> requirements and attached forms—additional local requirements may also apply. <br /> Submit completed forth to Local Unit of Government(LUG)and system owner NOV 13 2015 <br /> within 15 days <br /> CITY OF ORONO <br /> System Status <br /> System status on date(mmldd/yyyy): 9/3012015 <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 tl4)—Failing to protect groundwater <br /> ❑Operating permittmonitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range 0411723220032 <br /> Property address: 3085 Watertown Road, Orono, MN Reason for inspection: Property Transfer <br /> Property owner: Richard Gerhardt _ Owner's phone: 303-641-7602 <br /> or <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: ClyofOrono Regulatory authority phone: 952-249-4600 <br /> 2-1000 gallon septic tanks,1-1000 gallon lift 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 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: Pocallyy <br /> ls 's Soil&Perc.Testin License number: 810 <br /> Inspector signatuPhone number: 763-498-8779 <br /> Necessary or Required Attachments <br /> ® Soil boring logs ®SystemlAs-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 800-657-3864 . Available in alternative formats <br /> wq-wwists4-31 • 1124112 Page f of 3 <br />