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Minnesota Pollution Compliance Inspection Form <br /> c Control Agency <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) <br /> St.Paul,MN 55155-4194 - (£c- Doc Type:Compliance and Enforcement <br /> Kt- <br /> For local tracking purposes: <br /> Inspection results based on Minnesota Pollution Control Agency(MPGA) <br /> requirements and attached forms—additional local requirements may also apply. <br /> Submit completed form to Local Unit of Government(LUG)and system owner <br /> within 15 days <br /> System Status <br /> System status on date(mm/dd/yyyy): 7/2/2013 <br /> ® Compliant— Certificate of Compliance n 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 permit/monitoring plan requirements(Compliance Component#5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: 03-117-23-34-0015__ <br /> Property address: 2060 Weber Hills Road, Orono, Mn 55391 Reason for inspection: Property Transfer <br /> Property owner: Wells Fargo Bank, NA Owner's phone: _ <br /> or <br /> Owner's representative: Mark Representative phone: 952-915-2222 <br /> Local regulatory authority: City of Orono Regulatory authority phone: 952 249-4600 <br /> Brief system description: 2 Septic Tanks, Lift Station, Pressurized Mound <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: Dale Denn Certification number: 3226 <br /> Business name: George' Exc License number: 3368 <br /> Inspector signature: '# .� . Phone number: 612 310-7887 <br /> Necessary or Locally 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 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • 3/16/12 Page 1 of 3 <br />