HomeMy WebLinkAboutSeptic Compliance Inspection Form Minnesota Pollution Compliance Inspection Form
Control Agency
A-7_ Existing Subsurface Sewage Treatment Systems (SSTS)
520 Lafayette Road North
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 L
System Status
System status on date(mm/dd/yyyy): 1/23/2019
® Compliant— Certificate of Compliance ❑ 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
❑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: 1011723320014
Property address: 1270 French Creek Drive Reason for inspection: Property Transfer
Property owner: Matt Peterson Owner's phone: 914-406-3545
or
Owner's representative: Representative phone:
Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600
Brief system description: Approximately 3-1000 gallon septic tanks,1-1250 gallon lift station and 24X46 feet of chamber bed _
Comments or recommendations:
TBM:Top of door threshold. I meet Roger Peitso.The building inspector at the site for soils verifiction. It was the consensus that the
periodically saturated soils were located 64 inches below grade.
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: Joseph J Olson Certification number: 1255
Business name: Rusty Olson's Soil& Perc.Testing License number: 810
Inspector signature: _ Phone number: 763-498-8779
Necessary or Locally Required Attachments
0 Soil boring logs ® System/As-built drawing ❑ Forms per local ordinance
0 Other information (list):
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Property address: 1270 French Creek Drive Inspector initials/Date: J.O i 1/24/2019
(mm/ddlyyyy) ...__
1. Impact on Public Health —Compliance component#1 of 5
Compliance criteria: Verification method(s):
System discharges sewage to the ❑Yes ►1 No ® Searched for surface outlet
ground surface. ® Searched for seeping in yard/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 0"Black soil"above soil dispersal system
dwelling or establishment.
❑System requires"emergency"pumping
Any"yes"answer above indicates the 0 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, 0 Yes ® No 0 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. ❑ Examined empty(pumped)tanks(s)
If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil"
Any "yes"answer above indicates the ❑ Unable to verify(See Comments/Explanation)
system is failing to protect groundwater.
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
Elmer J. Peterson Company pumped the tanks
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:
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wq-wwists4-31b • 6/4/14 Page 2 of 3
Property address: 1270 French Creek Drive Inspector initials/Date: J.0 I 1/24/2019
(mm/dd/yyyy)
4. Soil Separation— Compliance component#4 of 5
Date of installation: 5/21/2015 ❑ Unknown Verification method(s):
(mm/dd/yyyy)
ShoretandNVellhead protection/Food beverage Soil observation does not expire. Previous soil
lodging? ®Yes 0 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 0 No ® Conducted soil observation(s) (Attach boring logs)
not located in Shore/and 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 0 No Comments/Explanation:
1996, or later or for non-performance
systems located in Shoreland or Wellhead
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 ❑ 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 92.1
2350 or 7080.2400 (Advanced Inspector
License required) B. Periodically saturated soil/bedrock 89.1
Drainfield meets the designed vertical C. System separation 3.0
separation distance from periodically
saturated soil or bedrock.
D. Required compliance separation* l 2.6
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 0 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 functionin•? ❑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.
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Page 3 of 3
Tank Report
Date: January 11, 2019
Elmer J. Peterson Co.
5921 Dague Ave.
Delano, MN 55328
Phone 763-972-2420
Fax 763-972-7217
MPCA License# 219
Matt Petersen
1270 French Creek Drive
Orono, MN 55391
914-406-3545
Baffles: DONOFF
Tank Capacity: 3-1000 Gallon Tanks. 1-1250 Gallon Lift Station Per City Records
#of Tanks: 4
Type of Tanks: Concrete
Gallons Pumped: 3500
Manholes to Grade: YES / NO
Comments:
On January 11, 2019, Elmer J. Peterson Co. uncovered 2nd manhole (12 inches deep) and pumped septic
tanks. Filter in the 3rd tank. 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: 1270 French Creek Drive Inspector initials/Date: 1/11/19 1
1. Impact on Public Health-Compliance component#1 of 5
Compliance criteria: Verification method(s):
System discharge sewage to the 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 El 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 into 0 Yes ❑ No El System requires"emergency"pumping
dwelling or establishment. ❑ Performed dye test
Any"yes"answer above indicates the system is El Unable to verify(See Comments/Explanation)
an Imminent Threat to Public 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.
0 Examined construction records
Seepage pits meeting 7080.2550 may be El Examined Tank integrity Form(Attach)
compliant if allowed in local ordinance.
El Observed liquid level below operating depth
Sewage tank(s)leak below their El Yes ® No ® Examined empty(pumped)tanks(s)
designed operating depth.
If yes,which sewage tank(s) leaks:
O Probed outside tank(s)for"black soil"
O Unable to verify(See Comments/Explanation)
Any"yes"answer above indicates the
system is Failing to Protect Groundwater. ❑ Other methods not listed(See Comments/Explanation)
Comments/Explanation:
On 1/11/19, Elmer J. Peterson Co.pumped septic 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* ❑No 0 Unknown
b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. ❑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* ❑No
*System is failing to protect groundwater
Explain:
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Soil Observation Log
www.SepticResource.com vers 12.4
Owner Information
Property Owner/project: Matt Peterson Date 1/23/2019
Property Address/PID: 1270 French Creek Drive.
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: ❑Till 0 Outwash ❑ Lacustrine ❑Alluvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit ❑ Shoulder 0 Side slope ❑Toe slope
soil survey map units: L4C slope % direction- Linear
Soil Log#1
0 Boring ❑ Pit Elevation 94.3 Depth to SHWT 64 Inches
Depth(in) Texture fragment% matrix color redox color consistence grade shape
0-10 Fill <35
10-22 Clay Loam <35 I0yr4/3 Firm Moderate Blocky
22-26 Clay Loam <35 10yr4/3 10y4/8 faint Firm Moderate Blocky
26-36 Loamy Sand <35 10yr5/3 Friable Weak Granular
36-64 Med Sand <35 l 0yr5/3 Loose Loose Single grain
Comments:
. 1270 French Creek Drive.
0 Boring ❑ Pit Elevation Depth to SHWT inches
Depth(in) Texture fragment% matrix color redox color consistence grade shape
64-72 Fine sand <35 10yr5/2 10y4/8,1-6/l0y Loose Loose Single grain
<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
>50 firm moderate prismatic platy
rigid strong massive
<35 loose loose single grain
friable weak granular blocky
35 -50
>50 firm moderate prismatic platy
rigid strong massive
loose loose
<3$ single grain
friable weak granular blocky
35 -50
>50 firm moderate prismatic platy
rigid strong massive
1270 French Creek Drive. Soil Log#2
0 Boring ❑ Pit Elevation 94.3 Depth to SHWT 64 Inches
Depth(in) Texture fragment% matrix color redox color consistence grade shape
0-40 Fill <35
40-50 Sandy Clay Loam <35 10yr4/3 Friable Moderate Blocky
50-60 Sandy Loam <35 10yr513 Friable Moderate Granular
60-64 Med Sand <35 10yr5/3 Loose Loose Single grain
64-72 Fine sand <35 10yr5/2 10y4/8,1-6/l0y Loose Loose Single grain
I hereby certifi,this work was completed in accordance with MN 7080 and any local req's.
Rusty Olson's Soil & Perc. 810
..-75"1"esigner Signature Company License#
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