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Home My WebLink AboutSeptic Repair Compliance Inspection Form Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155-4194 Doc Type:Compliance and Enforcement 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(mm/dd/yyyy): 10/30/2018 171 Compliant— Certificate of Compliance n Noncompliant— Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) frame outlined in Local Ordinance.) Reason(s)for noncompliance (check all applicable) El 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 El 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: 0611723110004 Property address: 4050 Bayside Road Reason for inspection: Mound repair Property owner: Thad& Danielle Steele Owner's phone: or Owner's representative: Dale Denn Representative phone: 612-310-7887 Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 Brief system description: Type I Mound Comments or recommendations: New Installation 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: Roger Peitso Certification number: #6683 Business name: License number: Inspector signature: � Phone number: 952-249-4625 Necessary or Locally Required Attachments ® Soil boring logs ® System/As-built drawing ❑ Forms per local ordinance ❑ Other information (list): www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31b • 6/4/14 Page 1 of 3 Property address: 4050 Bayside Road Inspector initials/Date: RLP 110/30/2018 (mm/dd/yyyy) 1 . Impact on Public Health — Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharges sewage to the ❑ Yes ® No ❑ Searched for surface outlet .round surface. ❑ Searched for seeping in yard/backup in home System discharges sewage to drain ❑ Yes ® No El Excessive ponding in soil system/D-boxes tile or surface waters. --- CI Homeowner testimony(See Comments/Explanation) System causes sewage backup into ❑ Yes ® No ❑ "Black soil"above soil dispersal system dwelling or establishment. ❑ System requires"emergency" pumping Any"yes"answer above indicates the ❑ Performed dye test system is an imminent threat to public ❑ Unable to verify (See Comments/Explanation) health and safety. ® Other methods not listed (See Comments/Explanation) Comments/Explanation: New installation and compliance inspection from 11/21/2017 2. Tank Integrity— Compliance component#2 of 5 Compliance criteria: Verification method(s): System consists of a seepage pit, ❑ Yes ® No ❑ Probed tank(s) bottom cesspool, drywell, or leaching pit. ❑ Examined construction records Seepage pits meeting 7080.2550 may be ® Examined Tank Integrity Form (Attach) compliant if allowed in local ordinance. ❑ Observed liquid level below operating depth Sewage tank(s) leak below their ❑Yes ® No designed operating depth. CIExamined empty(pumped)tanks(s) If yes,which sewage tank(s) leaks: ❑ Probed outside tank(s)for"black soil" Any "yes"answer above indicates the CIUnable to verify (See Comments/Explanation) system is failing to protect groundwater. ❑ Other methods not listed (See Comments/Explanation) Comments/Explanation: 3. Other Compliance Conditions—Compliance component#3 of 5 a. Maintenance hole covers are damaged,cracked, unsecured,or appear to be structurally unsound. ❑Yes* ® No ❑ Unknown b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. ❑Yes* ® No ❑ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. ❑Yes* ® No *System is failing to protect groundwater. Explain: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31b • 6/4/14 Page 2 of 3 Property address: 4050 Bayside Road Inspector initials/Date: RLP 111/10/2016 (mm/dd/yyyy) 4. Soil Separation — Compliance component#4 of 5 Date of installation: 10/16/1984 ❑ Unknown Verification method(s): (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage Soil observation does not expire. Previous soil El lodging? Yes ® No observations by two independent parties are sufficient, unless site conditions have been altered or local Compliance criteria: requirements differ. For systems built prior to April 1, 1996, and ❑ Yes ❑ No ❑ Conducted soil observation(s) (Attach boring logs) not located in Shoreland or Wellhead ® Two previous verifications (Attach boring logs) Protection Area or not serving a food, beverage or lodging establishment: ❑ Not applicable (Holding tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) separation distance from periodically ❑ Other(See Comments/Explanation) saturated soil or bedrock. Non-performance systems built April 1, ®Yes ❑ No Comments/Explanation: 1996, or later or for non-performance systems located in Shoreland or Wellhead Mound repair Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* "Experimental", "Other", or "Performance" ❑Yes Cl No Indicate depths or elevations systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 90.2 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soil/bedrock 87.2 Drainfield meets the designed vertical C. S stem separation 3 separation distance from periodically saturated soil or bedrock. D. Required com•liance separation* 3 Any "no"answer above indicates the system is *May be reduced up to 15 percent if allowed by Local failing to protect groundwater. Ordinance. 5. Operating Permit and Nitrogen BMP*— Compliance component#5 of 5 ® Not applicable Is the system operated under an Operating Permit? ❑ Yes ❑ No If"yes", A below is required Is the system required to employ a Nitrogen BMP? ❑ Yes Cl No If"yes", B below is required BMP=Best Management Practice(s)specified in the system design If the answer to both questions is "no", this section does not need to be completed. Compliance criteria a. Operating Permit number: ❑Yes ❑ No Have the Operating Permit requirements been met? b. Is the required nitrogen BMP in place and properly functioning? ❑ Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements (Minn. Stat. § 115.55)An imminent threat to public health and safety(ITPHS)must be upgraded, replaced,or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired,replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31b • 6/4/14 Page 3 of 3 Tank Report Date: September 1,2017 Elmer I Peterson Co. 5921 Dague Ave. Delano,MN 55328 Phone 763-972-2420 Fax 763-972-7217 MPCA License#219 Danielle Steele 4050 Bayside Road Maple Plain,MN 55359 (Orono) 612-849-9424 Baffles: OFF Tank Capacity: 3-1000 Gallon Tanks Per City Records #of Tanks: 3 Type of Tanks: Concrete Gallons Pumped: 3000 Manholes to Grade: 0/ NO Comments: On September 1,2017,Elmer J.Peterson Co.pumped septic tanks. No cracks or water leaking in tanks at that time. NOTE:This is only a tank report, This is not a compliance inspection for point of sale nor does it replace a compliance inspection. Property address: 4050 Bayside Road Inspector initials/Date; 9/1117 " Impact on Public Health-Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharge sewage to the f 0 Yes ❑No 0 Searched for surface outlet ground surface. 0 Searched for seeping in yard/backup in home System discharge sewage to drain tile 0 Yes 0 No ❑ Excessive ponding in soil system/D-boxes or surface waters. ❑ Homeowner testimony(See Comments/Explanation) ❑ "Black soil'above soil dispersal system System cause sewage backup into0 Yes 0 No 0 System requires"emergency"pumping dwelling or establishment. _ 0 Performed dye test Any"yes"answer above indicates the system is 0 Unable to verify(See Comments/Explanation) an Imminent Threat to Public Health and Safety. 0 Other methods not listed(See Comments/Explanation) Comments/Explanation: 2. Tank Integrity—Compliance component#2 of 5 Compliance criteria: Verification method(s): System consists of a seepage pit, 0 Yes ®No 0 Probed tank(s)bottom cesspool,drywell,or leaching pit. ❑ Examined construction records Seepage pits meeting 7080.2550 may be 0 Examined Tank Integrity Form(Attach) compliant if allowed in local ordinance_ ❑ Observed liquid level below operating depth Sewage tank(s)leak below their 0 Yes 0 No designed operating depth. ® Examined empty(pumped)tanks(s) If yes,which sewage tank(s)leeks: El Probed outside tank(s)for black soil" Any"yes"answer above indicates the ❑ Unable to verify(See Comments/Explanation) system is Failing to Protect G roundwater. ❑Other methods not listed(See Comments/Explanation) Comments/Explanation: On 9/1/17,Elmer J.Peterson Co.pumped tanks. 3. Other Compliance Conditions-Compliance component#3 of 5 a. Maintenance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. 0 Yes* 0 No 0 Unknown b. Other Issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. 0 Yes* 0 No ❑Unknown "System is an imminent threat to public health and safety Explain: c. System is non-protective of ground water for other conditions as determined by inspector 0 Yes' 0 No `System Is falling to protect groundwater Explain: www.pca.state.mn.us • 651-296-6300 • 800.657.3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 1124112 Page2of3 Soil Observation Log www.SepticResouree.com vers 12.4 Owner Information Property Owner/project: Danmielle Steele Date 10/12/2017 Property Address/PID: 4050 Bayside Road Soil Survey Information ❑ refer to attached soil survey Parent matl's: Till ❑Outwash ❑ Lacustrine ❑Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ Summit ❑ Shoulder Q Side slope ❑Toe slope soil survey map units: L41 E slope % direction- Linear Soil Log#1 ❑✓ Boring ❑ Pit Elevation 90.2 Depth to SHWT 46 Inches Depth (in) Texture fragment% matrix color redox color consistence grade shape 0-25 Fill <35 25-36 Topsoil <35 10yr312 Friable Moderate Blocky 36-40 Clay Loam <35 10yr413 Firm Strong Blocky 40-46 Clay Loam <35 10yr5/4 Friable Strong Blocky 46-54 Clay Loam <35 l0y75/3 10y4/8.1-6I10y Friable Strong Blocky Comments: 4050 Bayside Road Soil Log#2 0 Boring ❑ Pit Elevation 90.2 Depth to SHWT 28 Inches Depth(in) Texture fragment% matrix color redox color consistence grade shape 0-28 Fill <35 28-10 Topsoil <35 10yr3/I I0y4/8 Firm Strong riat� loose loose <35 single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive loose loose <J5 single grain 35 -50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive loose loose <J5 single grain 35 -50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive 4050 Bayside Road Soil Log#3 0 Boring ❑ Pit Elevation 90.2 Depth to SHWT 28 Inches Depth(in) Texture fragment% matrix color redox color consistence grade shape 0-28 Fill <35 28-40 Topsoil 35 10yr3/1 10y4/8 Firm Strong Pk* <35 loose loose single grain friable weak granular blocky 35-50 firm moderate prismatic platy >50 rigid strong massive loose loose single grain <�5 friable weak granular blocky 35 -50 firm moderate prismatic platy >50 rigid strong massive loose loose <J5 single grain friable weak granular blocky 35-50 firm moderate prismatic platy aty >50 rigid strong massive I hereby certify this work was completed in accordance with MN 7080 and any local reg's. `'____,,,,h Rusty Olson's Soil & Perc. 810 Designer Signature Company License# . 4050 Bayside Road Soil Log#4 0 Boring ❑ Pit Elevation 90.2 Depth to SHWT 28 Inches Depth (in) Texture fragment% matrix color redox color consistence grade shape 0-28 Fill .:3 5 28-40 Topsoil <-35 10yr3/1 10y4/8 Firm Strong Plat> <35 loose loose single grain friable weak granular blocky 35-50 firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain friable weak granular blocky 35 -50 firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain friable weak granular blocky 35 -50 firm moderate prismatic platy >50 rigid strong massive 4050 Bayside Road Soil Log#5 ❑ Boring ❑ Pit Elevation Depth to SHWT Inches Depth(in) Texture fragment% matrix color redox color consistence grade shape loose loose <35 friable weak single grain granular blocky 35-50 firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain friable weak granular blocky 35-50 >50 firm moderate prismatic platy rigid strong massive loose loose single grain <35 friable weak granular blocky 35 -50 firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain friable weak granular blocky 35 -50 firm >50 moderate prismatic platy rigid strong massive loose loose single grain <35 friable weak granular blocky 35 -50 >50 firm moderate prismatic platy rigid strong massive I hereby cerlifjr this work was completed in accordance with MN 7080 and any local req's. 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