HomeMy WebLinkAboutseptic info Minnesota Pollution Compliance Inspection Form
Control Agency
520 Lafayette Road North Existing Subsurface Sewage Treatment Systems
St.Paul,MN 55155-4194 ($$T$�
. Doc Type:Compliance and Enfor�ement
Instructions: Inspection results based on Mi�nesoia Pollution Control Agency(MPCA) For local tracking purposes:
requirements and attached forms-additionai 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(mmldd/yyyy): 8l812018
� Compliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance
(Valid for 3 years from report date, unless shorter fime (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 permiUmonitoring plan requirements(Compliance Component #5)-Noncompliant
Property Information Parcel ID#or Sec/Twp/Range: _0411723240019
___— _ _
Property address: 2915 Somerset Lane, Orono, MN Reason for inspection: Property Transfer
- ----
Property owner: Andrew Mills Owner's phone: _612-508-6607
— - ---- _ _ -- -- . — --- —
or
Owner's representative: Jeff Stalberger_ _ Representative phone: 763-442-9458
--- _ _ _ _.
Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600
_-- — _ _—_ _ —
Approximately 2-1250 gallon septic tanks,1-1500 gallon lift station and 750 square feet of mound
Brief system description: rockbed. Per ci�records
_ _ --- -__ - -- --
Comments or recommendations:
TBM: Bottom of the rock bed.The system has 1.0 feet of sand.
Certification
1 hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No
determination of future system pe�formance 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: Jose h J Olson Certification number: 1255
Business name: Rust�i O son's Soil&Perc.Testing License number: 810
__ __ _ _— - . _ - —
Mspector signature: --'- Phone number: 763-498-8779
Necessary or Locally Required Attachments
� Soil boring logs � System/As-built drawing ❑ Forms per locat ordinance
❑Other information (list):
_ _ __ _ ---- _ .-- —__ —
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wq-wwists4-31 • i/24/12 Page 1 of 3
Property address: 2915 Somerset Lane,Orono,MN Inspector initials/Date: J.O.8/08/18
1. impatt on Public Health —Compliance component#1 of 5
Compliance_criteria: Verification method(s�:
- ---- -� � �
System discharge sewage to the ❑Yes �No � Searched for surface outlet
rg ound surtace. ___ _� _ � Searched for seeping in yardlbackup in home
System discharge sewage to drain tile ❑Yes �No � ��ssive ponding in soil system/D-boxes
or surface waters. I ❑ Homeowner testimony(See Comments/Explenadon)
_ - ---
System cause sewage backup into � ❑Yes �No ❑ "Black soil°above soil dispersal system
dwelling or establishment. j ❑ System requires"emergency"pumping
--- -- �- ❑ Performed dye test
Any"yes"answer above/ndicates the system is ❑ Unable to verify(See CommentsiExp/anation)
an Imminent Threat to Public Heafth and Safety. ❑ Other methods not listed(see commenrs�xp�anariar�
Comments/Explanation:
2. Td11k Integr'ity—Compliance component#2 of 5
Compliance criteria: _ Verificatlon method(s):
System consists of a seepage pit, ; ❑Yes �No ❑ Probed tank(s)bottom
cesspool,drywell,or leaching pit. j ❑ Examined construction records
Seepege pits meeting 7080.2550 may be i ❑ Examined Tank Integrity Form(Attach)
comdient if elbwed 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/Exp/anation)
system is Failing to Protect Groundwater. �aher methods not listed(See Comments/Exp►anetion)
Comments/Explanation:
Elmer J Peterson Company pumped the tanks.
3. Othe�COmplidnCe Conditlons—Compliance component#3 of 5
a. Mairnenance hole�vers are damaged,cxacked,unsea�red,or appear to struc�urally unsound. p Yes• �No p Unkno�m
b. Other issues(e/ecdical hazards,etc.)to im�diately and adversely impad public heaKh or safety. O Yes" �No O Unknown
"System is an imminent tlirest to puWic hea/th and safety
Explain:
c. System is non-protective of ground water for other conditi�s as determined by inspecc:tor ❑Yes• �No
*System/s fa!ling 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 altemative formats
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Property address: 2915 Somerset Lane,Orono,MN ____ _ Inspector initials/Date: J.O.8/08/18
4. SOl( Sepat'etiOn—Compliance component#4 of 5
Date of installation: 10/29/02 ❑Unknown Verification method(s):
ShorelandANellhead prote�tioNFood Beverage �Yes �No Soil observafion does not ex ire. Pr+evious soil
Lodging? observa6ons by two inde�dent parties are suff'icient,
ComplianCe Criteria: un/ess site conditions have been altered orlocal
For systems built prior to Apri11, 1996, and
I ❑Yes ❑No �4uirt4ments differ.
nof located in Shore/and or Wellhead � Conducted soil observation(s)(Attach baing logs)
Protec6on Area or not serving a footl, ❑ Two previous veriflcations(Attach bori»g Iogs)
beverege or lodging establishment: ❑ Not applicable(Holding tank(s),r►o drain6eJd)
Drainfield has at least a two-foot vertical ❑ Unable to verify(See CommentsiExp/anatfon)
separation distance from periodically
saturated soil or bedrock. ❑ �ther(See Comments/Explana6on)
Non-performance systems built April 1, �Yes ❑No Comments/Fxplanation:
1996,or/ater or for non-perfo►mance
systems located in Shoreland or Wellhead ,
ProtecHon A�as or serving a food,
beverage, or lodging establishmenf: '
Drainfield has a three-foot vertical
separation distance from periodically
saturated soil or bedrock."
_ _.___ . i
"Experimental" "Othe►'; or "Perfom►ance" ` ❑Yes ❑No IndiCate depths of elevations
systems built under p►B-2008 Ru/es;Type IV � — T-
or V systems built under 2008 Ru/es(7080. A. Bottom of distribution media 100.0
2350 or 7080.2400 (Advanced Inspector
License required) , B. Periodically saturated soiubedrodc 97.3
-- - __ ___� —
Drainfield meets the designed vertical C. System separation ! 2.7
separation distance from periodically ' -- -----+----
saturated Soil Or bedrock. D. Repuired complianoe separation' ' 2.6
_ _ _ ___
Any "no"answer above indlcates the system is *May be reduced up to 15 percent if allowed by Local
FaI�f�9 fo Profect Groundwater. Ordinance.
5. Operating Permit and Nitrogen BMP'`—Comp�iance component#5 of 5 �Not applicable
Is the system operated under an Operating Permit? ❑Yes ❑No If"yes",A below Is roqufred
Is the system required to employ a Nitrogen BMP? ❑Yes ❑No If"yes",B below is required
BMP=Best Management Prac6ce(s)speciBed in the system design
If the answer to both questions is "no'; this section does nof need to be completed.
Compliance criteria
--- _ __--
a. Operating Permit number:
Have the Operating Permft requirements been met? � ❑Yes ❑No
—�------
b. Is the required nitrogen BMP in place and properly functioning? i ❑Yes No
Any"no"answer Indfcates Noncompllance.
Upgrade Requlrements(Minn.Stat.§115.55)An imminent thieat fo public health and satety(ITPHS)must be upgraded,replaced,or its use
discontinued within ten months of recsipt of fhis notice or wlthln a shorter perlod it required by local ordinance.lf the system is failing to protect
ground water,the system must be upgraded,replacad,orlts use dl�tinued wlthin the time required by loca/adinance.If en existing system
is not failing as defined in law,and has at least two feet of deslgn so!!separation,then the system need not be upgreded,ropeirod,rt9p/eCed,or
its use discontinued,nolwithstanding any loca!ordlnaiK:e that Is mo�e sbtct. Trils provlslon does not epply to Systems!n Sh0►@IAlld en998,
Wellhead Protection Areas,or those used in connectan wlth food,beverage,and lodging establishments as defined in law.
_ -- - — _..
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Tank Reuort
Date: �uiy 30,2a�s
Elmer 1.Peterson Co.
5921 Dagne Ave.
Delano,MN 55328
Phone 763-972-2420
Fax 763-972-7217
MPCA Licensd1219
Mdrew Mills
2915 Somerset Lane
Orono,MN 55356
812-508-6607
Baffles:��/ OFF
Tank Capac�ty; 2-1250 GaUon Septic Tanks,1-1500 Ga{bn Pump Tank
#of Tanks: 3
Type of Tanks: ��n Concrete
Gallons Pumped: 3000 - --
Menholes to Grade: YES / NO
Comments:
On July 30,2018,Elmer J.Peterson Co.uncovered manholes(1"-10 inches deep,2^0—8 inches deep,
liit atation to grade)and pumped tanks. No cradcs or watsr leaking in tsnks at that time.
NOTE:This is only a ffinlc roport. 'Ihis is not a compliancx inspa�ioa for poiat of sak nar dces it
tepla�x a complienco inspection.
f
P rtY P , } ry
Pro e address: _2915_Somerset Lane __ _ Ins ector initials/Date: __7/30/18 /' _
1. Impact on Public Hedlth—Compliance component#1 of 5
Compliance criteria: 1 Verifica6on method�s):
System discharge sewage fo the I �Yes ❑No ❑ Searched for surface outlet
ground surface. � ❑ Searched for seepmg in yard/backup in home
---__—
System discharye sewage to drain tile ' ❑Yes ❑No ❑ Excessive ponding in soil system/D-boxes
or surface waters. ❑ Homeowner tesdmony(See Comments�cp�anation)
System cause sewage backup into ❑Yes ❑No � �Black soil"above soii dispersal system
dwelling or establishment. ❑ System requires'emergenc�pumping
----- ❑ PeAormed dye tesl
Any"yes"answer above indicates the system is ❑ Unabte to verify�see canmentsFxaenetan�
8n Imminent Threat to Public Nealth and Safety. ❑ Other methods not listed(See Comments�Explanation)
CommentslExplanation:
2. Tdnk Integtity—Compliance component#2 of 5
Compliance criteria: Veriflcation method(s):
System consisis of a seepage pil, ❑Yes �No ❑ Probed tank(s)bottom
cesspool,drywell,or leaching pit. ❑ Examined oonstrudion records
Seepeqe pts meeting 7080.2550may be ❑ Examined Tank Integrity Form(Attech)
compliant il ellowed in local ordinence. � Observed liquid levei below opefating depth
Sewage tank(s)leak below their ❑Yes �No
_designed operating depth. � �mined emply(pumped)tanks(s)
-` — "— ❑ Probed outside tank(s)for'black soif'
If yes,which sewage tank(s)leaks: �
Arty"yes"answer above indicates the ❑ Unable to veriiy(See commem�xpienanav,)
sysfem is Failing to Pratect Groundwater. ❑Other methods not listed(See CommentsiExplanadon)
Comments/Explanation:
On 7/30/18,Elmer J.Peterson Co.pumped tanks.
3. Other Compliance Gonditions—Compliance component#3 of 5
a. Maintenance hole covers are damaged,cracked,unsecured,or appear to slruduraly unsound. ❑Ves' ❑No ❑Unknown
b. Other issues(eiecfricel n�e�ds,etc.)to immediately and adversely inpad public heatth or safety. p Yes` ❑No ❑Unknown
'System is an imminent threat to pt�bfic health and safety
F�cplain:
c. System is non-protective of ground water tor other conditions as detertnined by inspector ❑ves• p No
'System!s/alling to piotoct groundwater
Explain:
_ _..____ - -
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Soil Observation Log
�+�i��.tirpticRcsourcc.com�ers 12.4
Owner Information
Propeny Owner/project: .Andrew Mills Date 8/8/20l 8
Prop�m�Address: P1D: ?915 Somerset Lanc
Soil Sun�ev Information ❑ refer to attached soil survey
Parent matl's: �Till ❑Outwash � Lacustrine ❑Alluvium []Organic � Bedrock
landscape position: ❑Summit ❑Shoulder �Side slope ❑Toe slope
soil survey map units: L37f3 slope °�o direction-
Soil Log#1
Lj eoring ❑ P�t L;levation 101.0 Depth to SHWT 54 Inches
Uepth(in) Te�ture fragment°�o matrix color redox color consistence �rade shape
loose loose ,;,,g�e erai„
ft'lable Weak granular block�
0-24 Fill <35 -
finn moderate prismatic p�ac.
rigid strong n,assi��e
?4-36 Topsoil %35 10yr3!Z Friable Moderate [��ock.
36-42 Clay Loam �35 10yr4i3 Friable Strong I�lock�
42-54 Clay Loam v5 IOyrS/4 Friable Strong Rlock�
�3, loose loose ,;,,ble�ra;n
friable ��eak granular block�
35-50 finn moderate n � plai.
risma[ic
>50 rigid strong massivc
Comments: TBM: Bottom of the rock bed.
291� Somerset Lane Soil Lo #2
[�] Bonng � Pit Elevation 102.3 Depth to SHWT S6 Inches
Qepth (in) Texture fragment°�o matrix color redox color consistence grade shape
loose loose singlr grain
friable ��eak granular block�
0-36 Fiil <35
fii'nt moderate prismatic plat�
rigid strong "„""``
36-48 Topsoil �=3� 10�m3!1 Friable Modcratc Block�
48-�� Cla�•Loam <;5 I Oyr4/3 Friable Stron`� ������>
52-�6 Clay Loam �35 IOyrS?4 Friable Strong Bi�xk�
�6-6? Cla}�Loam <;5 IOyr5i4 10y4/8,1-6/IOy Finn Strong elock�
2915 Somerset Lane Soil Lo #3
❑ Boring ❑ Pit Elevation Depth to SHW'1"
Depth(in) Texture fragment°o matrix color redox color consistence grade shape
�OOSe �OOS2 single grain
<j1
3S-50 friable weak granular block}
tinn moderate prismatic platy
>50 ri�id strong �nassive
�OOSe �OOSe sjnele erdin
��5 friable weak granular block�
35-50 finn moderate pns�„au� ��ai,�
>50 rigid strong massive
, loose loose �����le grain
'S friable weak
.i5-50 granular block}
fn11 moderate prismatic plat�
>50 rigid strong mussive
�OOSC IooSe single grain
��5 frlable weak granular blocky
35-50 firm moderate prismatic platy
>50 massive
rigid stron�
IOOSC �OOS2 single�rain
��5 friable w08k granular block�
35 -50 �� modcratc prismatic plat�'
>50 rigid strong massive
/hereh��ce�•��his N�oi�k was canrpleted in accordance wilh A9N 7080 and anv locul req'.s.
� ;
Rusty Olson's Soil & Perc. 810
���signer Signature Company License#
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�z CITY of ORONU
._�;^,,.,� ..�_
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�a �������.,1.:..�,
'' �` .�+�� � Munici al Offices
�;��',�, ���4t���`f{��,`''����.,� G~� qsa-a49-ybo 0
�`\,�� �:,r�,..���,,t g,��/ Street Address: Mailing Address:
�� �E S K O,� 2 7 5 0 K e l l e y P a r k w a y P.O. B o x 6 6
��—�� Orono, MN 55356 Crystal Bay, MN 55323-0066
To Current Owner: Address: �%1 _'� ���,�.�, p�".'�c�?'
City Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every two years.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the categories checked below.
SYSTEM CONFORMITY (1-3): I
1 "CODE SYSTEM"An ISTS which meets all the location,design and construcdon standazds of the current Orono Municipal Code.
2 "COMPLIANT SYSTEM" An ISTS which does not meet all the location,design and consGvcdon standards of the current Orono
l�iunicipal Code but does meet the three foot separation requirement or two foot requirement for systems installed 1996 or earlier,and
which is not failing or an imminent threat to public health or safety.
3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-year flood plain,any ISTS which may
or may not meet all the location,design,or construction standards of the current Orono Municipal Code and which is failing for any
reason;and any ISTS with less than three feet of unsaturated soil or sand between the distribution device and the limiting soil characteristics.
TANK CONDITION(5-7): S_
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Septic tanks must be pumped out this year (city code recommends tanks to be pumped out once every 3 years.
Tank was last pumped ).
Make sure septic tanks are pumued throueh manhole and not throu¢h white inspection pipes. This allows for the proper
cleanine. Keea�vater softner and iron filter discharae out of seatic svstem to arolons life of drainfield. Ask oumaer to test
alarm float to verifv alarm is stil!working in your hause. The alarm warns owner that seataee is about to backup into basement.
7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)rnust be installed in each tank. If
tanlcs have not been pumped out within the last three years,they should be pumped out now.
DRAINFIELD CONDITION l8-101: �
8 Drainfield is dry,no surfacing evident.
9 Some evidence of surfacing,not critical yet.
10 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately.Repairs must be completed within 90 days.
COMMENTS:
�-9 r �,� .�- �
�S ,� ..;� �
Date of Inspection Septic System Inspector
SEPTIC SYSTEM INVENTORY
Site Address: 2915 Somerset La PID 04-117-23-24-0019
Owner Name: Brent& Nancy Bordson
Owner Address: 2915 Somerset La Long Lake MN 55356-
BuildingTvpe: residence Installer: J.S. Stewart
Date of Permit: 10/29/02
System Type: mound BR's Designed for 6
In Musa?: no Shoreland?:
SEPTIC TANKS:
Material: precast concrete Capacity: 1250, 1250, 1500 Tank Filter: no
DRAINFIELD:
Treatment Area: 40x93 Soil Boring: DF Ht above Wt: 3
WELL DATA
Setbacks -Well Tanks: 100+ Well DF: 100+ Report In File: Depth:
INSPECTION RECORDS PUMPOUT RECORDS____
Date Notes I Date GallonsOfLiquid
7/25/2005 inspection 7/30/2018 3000
7/25/2005 inspection 9/22/2010 3500
10/29/2002
10/29/2002
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