The URL can be used to link to this page

Home My WebLink AboutSeptic 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(mmidd/yyyy): 4/25/2018 ® Compliant— Certificate of Compliance E 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) ❑ 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: Property address: 1235 Lyman Ave, Orono Reason for inspection: sale Property owner: Paul Pesek Owner's phone: 952-476-2300 or ---- -- -- — Owner's representative: — _ _ Representative phone: Local regulatory authority: City of Orono Regulatory authority phone: Brief system description: 2-1000 septics& 1000 gal pump tank with a 3 bedroom mound system Comments or recommendations: ---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: Josh Swed . d Certification number: C1659 Business name: Sewer S fifes In License number: 2502 Inspector signature: .� ' Phone number: 952-873-3292 Necessary or L. ally Required Attachments ® Soil boring logs ® System/As-built drawing ® Forms per local ordinance 0 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-wwists4-31 • 3/16/12 Property address: 1235 Lyman Ave, Orono Inspector initials/Date: JS 14/25/2018 (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 ground surface. i Searched for seeping inyard/backup in home System discharges sewage to drain ❑Yes ® No ❑ Excessive ponding in soil system/D-boxes tile or surface waters. ❑ Homeowner testimony(See Comments/Explanation) System causes sewage backup into ❑ Yes ® No ❑ "Black soil"above soil dispersal system dwelling or establishment. i — ❑ 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: 2. Tank Integrity—Compliance component#2 of 5 Compliance criteria: Verification method(s): System consists of a seepage pit, ❑Yes ® No 0 Probed tank(s)bottom cesspool, drywell, or leaching pit. ® Examined construction records Seepage pits meeting 7080.2550 maybe j ❑ Examined Tank Integrity Form (Attach) compliant if allowed in local ordinance. Sewage tank(s)leak below their ❑ Observed liquid level below operating depth ❑Yes ® No designed operating depth. ® Examined empty(pumped)tanks(s) If yes,which sewage tank(s) leaks: j ❑ Probed outside tank(s)for"black soil" Any "yes"answer above indicates the El Unable 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. 0 Yes* ®No ❑Unknown b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. ❑Yes* Z No 0 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' ®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-wwists4-31 • 3/16/12 Page 1 of 3 P.roperty address: 1235 Lyman Ave, Orono Inspector initials/Date: JS i 4/25/2018 (mm/dd/yyyy) 4. Soil Separation —Compliance component#4 of 5 Date of installation: 7/11/1984 0 Unknown Verification method(s): (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage Soil observation does not expire. Previous soil 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 0 Yes ❑ No ® Conducted soil observation(s)(Attach boring logs) not located in Shoreland or Wellhead Protection Area or not serving a food, 0 Two previous verifications(Attach boring logs) 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 Boring: Protection Areas or serving a food, 1-20" 10YR 2/2 Loam beverage, or lodging establishment: 21-25" 10YR 4/4 Clay Loam Drainfield has a three-foot vertical separation distance from periodically No Redox saturated soil or bedrock.* "Experimental" "Other", or "Performance" ❑ Yes 0 No Indicate depths or elevations systems built under pre-2008 Rules; Type IV i —or V systems built under 2008 Rules(7080. A. Bottom of distribution media 12"+ 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soil/bedrock I 25"+ _ Drainfield meets the designed vertical C. System separation 36"+ separation distance from periodically — ----- -- saturated soil or bedrock. D. Required compliance separation* 36" 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 0 No If"yes",A below is required Is the system required to employ a Nitrogen BMP? ❑Yes ❑ 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: Have the Operating Permit requirements been met? ❑Yes ❑ No b. Is the required nitrogen BMP in_place and properly functioning? 0 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-wwists4-31 • 3/16/12 Page 3 of 3 Sewer Services, Inc. Invoice 25648 200th Street Belle Plaine, MN 56011 Date Invoice# 952-873-3292 Swedlunds, Sullivans, Thaemert 4/26!2018 I 1120 :,,, • •, Bill To .11 Pesek. Paul 1235 Lyman Avenue Orono.Minnesota 55391 P.O. No. Terms Project Due on receipt Description Qty Rate Amount Residential Pumping 4/25/18 299.00 299.00 1st 1000 Gallons Pumped Residential Pumping 1.5 99.00 148.50 Add'I 1500 Added 34'of Riser 118.50 118.50 Septic Compliance Inspection-Residential 399.00 399.00 Filing fee for Disposal 5.00 5.00 Total `1:970.00 Payments/Credits 4970.00 Balance Due $0.00 Sewer Services, Inc. 25648 200th Street Belle Plaine, MN 56011 952-873-3292 Swedlunds, Sullivans, Thaemert 25648 200th Street 05/09/2018 SALE Total: $399.00 MasterCard xxxxxxxxxxxx2105 Exp. Date: xx/xx Name: Paul Pesek Auth. Code: 03903B QuickBooks Trans. No: Trans. ID: P10161082702 Merchant No.: 5247710019681790 Thank you for your business CUSTOMER COPY