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Oct 14 13 06:21 a Joseph Olson 1 763-498-8290 p.2 <br /> r��� � <br /> � �� <br /> . Mir�nesotaPollution � �y Compliance Inspection F'orm <br /> ContrQl Agen�y �� �� <br /> 520 Lafayette Road Narth Existing Subsurface Sewage Treatment SysteMs <br /> St.Paul,IllIN55155-4794 � �$$T$� <br /> Doc Type:Compliance and Enforr,ement <br /> Instructions: �nspeetion resuits based on Minnesoia Pollution Corrtrol Agency(MPCA} For local tracking purposes: <br /> requirements and attached forms-additional local requirements may also apply. � <br /> Submit completed form to Local Urtit of Govemment(LUG)and system owner <br /> withi�15 days <br /> System Status <br /> System status on date(mmldd(yyyy�: 8/3012013 <br /> � Gompliant-Certificate of Compliance ❑ Noncompliant-Natice of Noncompliance <br /> (Valid for 3 years from report date, unless shorfer Sme (See Upgrade Requr�rnenfs on page 3J <br /> Irdme outlined in Loca!Qrdinance.) <br /> Reason(s)for r�oncompliance(eheck all applicable) <br /> ❑ Impact on Public Health(Compliance Component #1J-Imminent threat fo pub�c health and safety <br /> ❑ Other Compliance Conditions(Compliance Component#3)-lmminent threat fa public heafth and safety <br /> ❑Tank Integrity(Compliance Component #2J-Failing to protect groundwafer <br /> ❑ Qther Compliance Conditions(Compliance Componenf#3)-Failing to protect groundwater <br /> ❑ Soil Separation (Compliance Gomponent #4)-Failing fo protecf groundwater <br /> ❑ Operating permiVmonitoring plan requirements(Compliance Component #5)-NoncompGant <br /> Property Information Paroel ID#or SeclTwplRange: 04-117-23-34-0013 <br /> Property address: _307o Farview lane,Orono, MN Reason#or inspection: Property 7ransfer <br /> Property owner: Da�e Silus Owner's phone: <br /> or — - _ ._ _ <br /> owners representative: Gregg Larsen Representative phone: &12-719-4477 <br /> Local regulatory authoriiy: City of Orono Regulatory authoriiy phone: 952-249-4600 <br /> 2-1000 gallon septic tanks,3-500 gallon lifi station and approximalely 500 square feet of mound <br /> 8rief system description: rockbed. <br /> Comments or recommendations: T <br /> Certification <br /> I hereby certify that all the necessary info�ma6on has beerr gathered to deterrnine the compfrance status of this system. !Vo <br /> determination of future system perlom�ance has been nor caR be made due to unknown conditions dunng system construction, <br /> possible abuse oithe system,rnadequatemaintenance, orfuture waterusage. <br /> lnspector name: Joseph J Olson CertificaFion number. 1255 <br /> Business name_ RustY Olsan's Soi1 8�Perc.7esting License nurnber: 810 <br /> Inspector signabure: --'�� Phone number_ 763-�98-8779 <br /> ,� �-- -- <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•296-630o • 800-657-3854 • 7TY 651-282-5332 or 800-557-3864 • Available in altemative formats <br /> wq-wwists4-31 • �l24112 Fage 1 of 3 <br />