Laserfiche WebLink
MOM Minnesota Pollution <br /> Control <br /> Agency Compliance Inspection Form <br /> Co <br /> 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems <br /> St.Paul,MN 55155-4194 (SST$) <br /> Doc Type:Compliance and Enforcement <br /> Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: <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): 11/9/2017 <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 #4)—Failing to protect groundwater <br /> ❑Operating permit/monitoring plan requirements(Compliance Component #5)—Noncompliant <br /> Property Information Parcel ID#or Sec/Twp/Range: 3311823440041 <br /> Property address: 125 TrufFala Trail,Orono MN Reason for inspection: Property Transfer <br /> Property owner: Jeff Joerres Owner's phone: 612-840-3779 <br /> or <br /> Owner's representative: Representative phone: <br /> Local regulatory authority: City of Orono Regulatory authority phone: 952-2494600 <br /> 2-1000 gallon septic tanks,1-1000 gallon lift station and 500 square feet of mound rockbed.per city <br /> Brief system description: records <br /> Comments or recommendations: <br /> The electrical box for the lift station should be reattached to the wood post. <br /> Certification <br /> 1 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: Rusty O on's Soil&Perc.Testing License number: 810 <br /> Inspector signature: — Phone number: 763498-8779 <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 - 890-657-3864 TTY 651.282-5332 or 800-657-3864 - Available in alternative formats <br /> wq-ww1sts4-31 - 1124112 Page 1 of 3 <br />