12/01/2020 Comp. Inspect. Form - NON COMPLIANT

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Minnesota Pollution Compliance Inspection Form Control Agency N 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems St. Paul, MN 55155-4194 (SSTS) Doc Type: Compliance and Enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency (MPCA) [For local tracking purposes: requirements and attached forms — additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mmiddlyyyy): 12/1/2020 ❑ Compliant Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) ® Noncompliant — Notice of Noncompliance (See Upgrade Requirements on page 3) ❑ Impact on Public Health (Compliance Component #1) — Imminent threat to public health and safety ❑ Other Compliance Conditions (Compliance Component #3) — Imminent threat to public health and safety ❑ Tank Integrity (Compliance Component #2) — Failing to protect groundwater ❑ Other Compliance Conditions (Compliance Component #3) — Failing to protect groundwater ® Soil Separation (Compliance Component #4) — Failing to protect groundwater ❑ Operating permit/monitoring plan requirements (Compliance Component #5) — Noncompliant Property Information Parcel ID# or Sec/Twp/Range: 3611823310012 Property address: 250 Wakefield Road, Orono, MN Reason for inspection: Property Transfer _ Property owner: Virginia Craven or Owner's phone: Owner's representative: Jon Arne Representative phone: 952-270-8390 _ Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 Brief system description: _ Approximately 2-10p0 gallon septic tanks and 750 square feet of trench system. Per City records. Comments or recommendations: TBM: Top of the door threshold. ELV-100.0 assumed Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Joseph J Olson Business name: _Rusty Olson's Soil & Pere. Testing Inspector signatur Necessary or Locally Required Attachments 2 Soil boring logs M System/As-built drawing ❑ Other information (list): www.pca.state.mn.us • 651-296-6300 800.657-3864 wq-wwists4.39 • 1124192 Certification number: 1255 License number: 810 Phone number: 763-498-8779 ❑ Forms per local ordinance • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page Iof3