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 Enforcenjent 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 Unitlof Government(LUG)and system owner within 15 days System Status o System status on date(mmidd/yyyy): 2/19/2019 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 (C4mpliance 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)–Failingto 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 SeclTwp/Range: Property address: 4745 Creekwood Trail,Orono _ Reason for inspection: _sale Property owner: Colleen Yockey Owner's phone: 612-581-0764 or Owner's representative: _— Representative phone: Local regulatory authority: City of Orono _ Regulatory authority phone: Brief system description: 1250& 1000 septic&1250 Gallon pump tank with a mound system Comments or recommendations: Certification I hereby certify that all the necessary infprmation 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 SwedluCertification number: C1659 Business name: Sewer Sega In Air License number: 2502 Inspector signature: t7 / 4 •. Phone number: 952-873-3292 Necessary or Locally Required Attachments ® Soil boring logs E System/As-built drawing E 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-wwists4-31 • 3/16/11 Page 1 of 3 Property address: 4745 Creekwood Trail, Orono Inspector initials/Date: JS l 2/19/2019 (mm/ddlyyyy) 1. Impact on Public Health -Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharges sewage to the 0 Yes ® No ❑Searched for surface outlet _ground surface. ® Searched for seeping in yard/backup in home System discharges sewage to drain 0 Yes ® No 0 Excessive ponding in soil system/D-boxes tile or surface waters. 0 Homeowner testimony(See Comments/Explanation) System causes sewage backup into 0 Yes ® No 0 "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. 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 0 No 0 Probed tank(s) bottom cesspool, drywell, or leaching pit. Examined construction records Seepage pits meeting 7080.2550 maybe ❑ Examined Tank Integrity Form (Attach) compliant if allowed in local ordinance. Sewage tank(s) leak below their ❑Yes 0 No 0 Observed liquid level below operating depth designed operating depth. rExamined 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. 0 Other methods not listed (See Comments/Explanation) Comments/Explanation: cleaned and inspected tanks 3/7/ 018 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. El 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-wwists4-31 • 3/16/12 Page 2 of 3 • Property address: 4745 Creekwood Trail, Orono Inspector initials/Date: JS I 2/19/2019 (mm/dd/yyyy) 4. Soil Separation — Compliance component#4 of 5 Date of installation: 5/15/1992 j 0 Unknown Verification method(s): Shoreland/Wellheadprotection/Food be mm/dd/yyyy) verage Soil observation does not expire. Previous soil lodging? ❑ Yes independent observations by two 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 tE 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 drain field) Drainfield has at least a two foot vertical a Unable to verify(See Comments/Explanation) separation distance from periodically a Other(See Comn,ents/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, 1-26" 10yr 2/2 loam beverage, or lodging establishment: No Redox Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock." "Experimental", "Other", or "Performance" ❑ Yes ❑ No Indicate depths or elevatiions systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules(7080. A, Bottom of distribution media 12"+ 2350 or 7080.2400 (Advanced Inspector License required) El. Periodical) saturated soil/bedrock 26"+ Drainfield meets the designed vertical C. System separation 36"+ separation distance from periodically saturated soil or bedrock. C. Required compliance separation* 24" Any "no"answer above indidlates 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 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 propery functioning? I 0 Yes No Any "no"answer indicates Noncompliance. Upgrade Requirements (Minn. Stat. § 115.55)An imminent threat to public health and safety(ITPHS)must he upgraded, replaced, or its use discontinued within ten months of recent 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 , . . , L/NS- Cree . 'kit:Cti ICC \ . N + ljell 1 I i . , 1 } IIIIIIIIIIH 0 0 I \) 1 \ , I .._.x 7 1 1 I , I -----j 1 1 A 13 c , -r, 1.,, 16,3 I gy,,s q,,s , 1 .,,,- `11.to 46'4 i-r, II, Viv La/ i w Mit VC S310 al- 3ski xi% Il; /611- Lp'o .9ro lcill ..... ...r. 334 LW(*) , . 1