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Sep 02 09 08:1� Joaeph Oleon 763�986290 p.2 i � Minnesota Pollution Compliance inspection Form Control Agency � 520 l.afayette Road North Exisling guL�uriace Sev�rage 7 realment y�/sterr�s (SSTS) Sc.Paul.MN 5515r�4194 Instructions on page 7 � Parc�1 number: —.---._._...__...._ .. � For Local Track's�g PurPcsos; System st�tus: I$I Compliant ❑Noncanpliant � re��e o�en�e��, � �, sarnmary For�» Property Information Pro�rty ovmer name(s): Todd 8 Amy liactman �__.�_ Property address: 60 Mvrpewood Road.Orono,MN 55391 �.__.,... _ ..._._.. __.. �__._._..— Propercy aMmers address C�d�rerer�): Cnunry: Hennepin Property owner phone: 612-518-2291 PeRnitting aulhorily: . City vf orono Date system oonsbucied: 9/2�189 Reason for inspedion: Pra Transfer System DescriptiOn Approximabaly 2-1000 gallan sepdc lanks.1-1000 gaUon 51t station and Approxi�r�srtely 680 square Brie�f syseem descxiption: feet of mound rockbed. Lo�l pemiit number_ 2299 Namber oF bedrooms: 5 ._. Design flaw r�te: �83... ............_.._ ls the s�rs�m: In Sfwr�eland at�ea? ❑Yes �No In Wellhead Prot�ection Area? ❑Yes �No An U.S.ErwironmeMal Prntecticn System serving a Minnesota Oapartment Agency(EPA)Class v�njedion we0?D Yss �No ot Hea1h(MOH)tioensed facilisy? Q Yes � No Complian�e Status�s�ed o�st�ce req��rome�cs-addi6o�l local requirements may also apply.� Based on the i�formation gathered aRd repated on atrached fonru,t�e oompl'�smce status of th�sysiem Is(chedc one): �Certificate af Compliance-vafid un�l(3 years fiam date af re�port�: 9H 2O12 ❑NptiCe pf Npncpmplianoo-Fvr Npncp�iant sys�ms: 7he reason for no�compliance is: ... .....---.... ...._...._..--•-•-- .. This noncompliarrt system is clsssified as(check o�e below�: ❑ Imminent threat to public health 8 safery [a FaiG�g to proEect ground water ❑Not in complianae with oporaon8 pertnit C@rt1�1Cat10�1(Ccmpleted furm must be submitted to the bcal u�it of goMemment within i 5 days.) l hereby cortdy lfist eJl tho naco�ssery irdormabon tu�s been gati�er�sd to Qetsrrrw�e the corrlplisrnoe status ot tAis system_h/n determu►ation offi,ture systr�m yerlormance has Deen norcan bo�made due t�o unlv�cwn ca�dr[ans during sysbem con�a�. possibre abuse of fh�e system,inedequate meinrenance,or future water usage. Name: Joaeph J.OIssQnn _� _..�, ... Ce�ti�icatan number: 1255_ Busir�ess lir�se name and number. Rusty Olson's soil and perculation tes�n�Lic#810 � or Name aE loeal urot goverrment� City of uro►m Signature: - Date: 9/01/09__....�._..,..,� Required Attachme�ts i�s�ctor Complete:This laspec�ion Report is pages Eon9- CheCk complianoe fQrms atbcheci: �HydrauUc PeaformanCe ❑7aek Irnegrit�r �So1 Separetion ❑Oqer�ting PermR Form(f applicable) Q Sysiem drawinglAs-buiR drawing ❑An assessment of any beal requiren�e�s that are�ferent f►om what is roqulree oo t�is form �Soil Boring Loga �Ahar�donment farm(if approprlalo) ❑Oeher information(tis�: U(�graCi�Rs�ufns�nsMs(aerlvetl i�Dm Minn.Sfet§�75�55I An hnnJ�+aM lnroat to P�+�(e AeaR'n exd+aMtY fA'PNS1 nwsf Os uPO�+�vo4►s��ltcod or fls Hse O+�COI1NAl/e0 wXMA te!!/AOM►18 o�/eCo1O�o/W8/IOdC9 wW�N+e s�+011s�OeIloOl�/b0lMled Ay loCa!onDAwllOe:If MY 6yshrR ti f�N�f0 P�Mtt 9r�wr�d weMr.U1s arysEam mu�be upy�adls4 rsyNo�d or ds tos�Sroar�GMesd wldiln Cie Nmv�equlred by Mcel oedlneaco.Nen exktlrp sy�an�!s not 1�Nhry a8 Oelfne0 M lew,and Aes�!�ea.�t 1wo/est a�ds�lyur sdl s�paraNan.then rhe system n�ad rrot be uPBiaoso,re�elreo iapreceo.or Im u�e olaoantlrxrea,nawlmpenCiny any Ioa/o►r�+na�e mat k marc�»ct rn�s pvardabn daea r,or eppiy to symie�„e/n anoreJene an.e� WdM�ed orotucrbn p�a c�lo�se useu�+connecUar�wiB,lood nsve�a,anC IoOQx�e�adPsnments ae oellrieo M law. wq-ww;sts4.3� Comp(iance lnspecciar�Form fa Ex�stl�q SSTS 4/4/08