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HomeMy WebLinkAboutSE18-000004 (Septic Compliance Inspection Form) • ` :. Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North 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. New System System Status System status on date(mm/dd/yyyy): 12/14/2018 ® Compliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance (Valid for 5 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: Property address: 1140 Wyndmere Road Reason for inspection: New System Property owner: Owner's phone: or Owner's representative: Metro General Service Inc. Representative phone: 763-428-2938 Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 Brief system description: Type I Mound Comments or recommendations: Mound Repair 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 v'�11 Necessary or Locally Required Attachments ® Soil boring logs ® System/As-built drawing 0 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-ww1sts4-31b • 6/4/14 Page 1 of 3 Property address: 1140 Wyndmere Road Inspector initials/Date: RLP 112/14/2018 (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. ❑ 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 ❑ "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 system installation 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 compliant if allowed in local ordinance. ❑ Examined Tank Integrity Form (Attach) Sewage tank(s) leak below their El Yes ® No ❑ Observed liquid level below operating depth 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 ElUnable to verify(See Comments/Explanation) system is failing to protect groundwater. ® Other methods not listed (See Comments/Explanation) Comments/Explanation: Brand new 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: 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: 1140 Wyndmere Road Inspector initials/Date: RLP 112/14/2018 (mm/dd/yyyy) 4. Soil Separation — Compliance component#4 of 5 Date of installation: 12/14/2018 ❑ 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 Protection Area or not serving a food, ['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 New system installation 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 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soil/bedrock Drainfield meets the designed vertical C. System separation separation distance from periodically saturated soil or bedrock. D. Required compliance separation* 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 ❑ 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 0 N 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 s ONo City of Orono Septic Asbuilt Form 1140 Wyndmere Road Building Use: Residence Address: - Metro General Services Inc License# L1546 Date: 5/14/2018 Installer; 4 Septic Tanks: 2250 Pump Tank: 1250 Date Finaled: Bedrooms# System Type: X I I I III I III Ix I Mound I I Trenches Pressure Bed I I Other Draw detailed diagram with measurements indicating distances to tank Risers. Use two(2) points from a permanent structure. Show locations of drop Boxes and length of trenches A B 1 15J 1 Y/ 21g 3 ZY i S 4 22 5 jjh2I 231 7 8 9 10 11 12 j PROPERTY LIN wesied area 20' 4 enemataNORTH sem _ P .rereei 90x50+ ML.dee 85a y Proposed 1 1000 Cakes w Pomp Teak •, it vD AKA iFho will prp 60'UPI* \\\i`�.�C! 1 be 81101 upon Lane 60' completion of Proposed 2S00 walkoutGallon Sep ek Proposed Proposed 200'Maki law -rink House L---------_______1_4) cieeeosa f Cleanout L i i PWWthIY UNE ....M. Soil Observation Log www.SepticResource.com vers 12.4 Owner Information Property Owner/project: David Gange Date 11/1/2017 Property Address/PID: 1140 Wyndmere Rd. Soil Survey Information 0 refer to attached soil survey Parent matl's: pm ❑Outwash ❑Lacustrine ❑Alluvium ❑Organic ❑ Bedrock landscape position: ❑Summit ❑Shoulder ❑Side slope ❑Toe slope soil survey map units: L221)2 slope 12 % direction-downhill L22C2 Soil Log#1 Q Boring ❑Pit Elevation Depth to SHWT 15" Depth(in) Texture fragment% matrix color redox color consistence grade shape 0-10 sandy loam <35 10YR3/3 Loose Moderate Granular 10-17 sandy loam <35 10YR4/6 Friable Weak Granular 17-26 sandy loam <35 10YR3/4 Loose Loose Single grain 26-36 sand <35 10YR3/4 5YR5/8 Loose Loose Single grain loose loose <35 single grain friable weak granular blocky 35-50 flint moderate prismatic platy >50 rigid strong massive Comments: . ' 1140 Wyndmere Rd. Soil Log#2 U Boring ❑Pit Elevation Depth to SHWT 24" Depth(in) Texture fragment% matrix color redox color consistence grade shape 0-11 sandy loam <35 10YR3/2 Friable Weak Granular 11-17 sandy loam <35 10YR4/6 Friable Weak Granular 17-21 loamy sand <35 10YR4/6 Friable Weak Granular 21-34 sand <35 10YR3/4 Loose Loose Single grain 34-42 loamy sand <35 10YR3/4 5YR5/8 Friable Weak Granular 1140 Wyndmere Rd. Soil Log#3 0 Boring ❑ Pit Elevation Depth to SHWT Depth(in) Texture fragment% matrix color redox color consistence grade shape 0-7 sandy loam <35 10YR3/3 Friable Weak Granular 7-18 sandy loam <35 10YR4/6 Friable Weak Granular 18-22 sand <35 10YR4/6 5yR5/8 Loose Loose Single grain 22-28 sand <35 10YR3/4 5YR5/8 Loose Loose Single grain loose loose <35 single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive I hereby certify this work was completed in accordance with MN 7080 and any local req's. Ende Septic Service C9206 Designer Signature Company License# • , ` 1140 Wyndmere Rd. Soil Log#4 El Boxing ❑ Pit Elevation Depth to SHWT_ 18" Depth(in) Texture fragment% matrix color redox color consistence grade shape 0-6 loam <35 10YR3/2 Friable Moderate Blocky 6-18 loam <35 _ 10YR4/4 Friable Moderate Blocky 18-22 clay loam <35 10YR4/6 5YR5/8 Loose Moderate Blocky 22-30 clay loam <35 10YR5/4 5YR5/8 Friable Strong Blocky loose loose <35 single grain friable weak granular blocky 35-50 fum moderate prismatic platy >50 rigid strong massive 1140 Wyndmere Rd. Soil Log#5 ❑ Boring ❑pit Elevation Depth to SHWT 20" Depth(in) Texture fragment% matrix color redox color consistence grade shape 0-11 loam <35 10YR3/2 'Loose Weak Blocky 11-20 clay loam <35 10YR4/4 Friable Strong Blocky 20-30 clay loam <35 10YR4/6 5YR5/8 Friable Moderate Blocky <35 loose loose single grain friable weak granular blocky 35 -50 firm moderate prismatic platy >50 rigid among massive loose loose <35 single grain friable weak granular blocky 35-50 firm moderate prismatic platy >50 rigid strong massive I hereby certifi,this work was completed in accordance with MN 7080 and any local req's. Ende Septic Service C9206 Designer Signature Company License# UNIVERSITY '~, OF MINNESOTA Septic System Management Plan for Above Grade Systems The goal of a septic system is to protect human health and the environment by properly treating wastewater before returning it to the environment. Your septic system is designed to kill harmful organisms and remove pollutants before the water is recycled back into our lakes, streams and groundwater. This management plan will identify the operation and maintenance activities necessary to ensure long- term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic maintainer or service provider. However, it is YOUR responsibility to make sure all tasks get accomplished in a timely manner. The University of Minnesota's Septic System Owner's Guide contains additional tips and recommendations designed to extend the effective life of your system and save you money over time. Proper septic system design,installation,operation and maintenance means safe and clean water! Property Owner David Gange Email Property Address 1140 Wyndmere Rd. Orono Property ID 2611823410014 System Designer Ende Septic Service Contact Info 763,428-4489 System Installer fleiio _eeet e c,/ eU v(C Pr 6, Contact Info -70-/405-z..73 8 Service Provider/Maintainer Ende Septic Service Contact Info 763-428,..4489 Permitting Authority City of Orono Contact Info 662.'Z, ?— 2/.660 Permit# 56/g - (q©©©0 Date Inspected /27/1.1---74 Keep this Management Plan with your Septic System Owner's Guide. The Septic System Owner's Guide includes a folder to hold maintenance records including pumping, inspection and evaluation reports. Ask your septic professional to also: • Attach permit information,designer drawings and as-built of your system, if they are available. • Keep copies of all pumping records and other maintenance and repair invoices with this document. • Review this document with your maintenance professional at each visit;discuss any changes in product use,activities,or water-use appliances. For a copy of the Septic System Owner's Guide, visit www.bookstores.umn.edu and search for the word "septic"or call 800-322-8642. For more information see http://septic.umn.edu Version:August 2015 - 1 -