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Home My WebLink Aboutseptic info i Minnesota Pollution Compliance Inspection Form vd Control Agency 520 Lafayette Road worth Existing Subsurface Sewage Treatment Systems (SETS) St.Paul,MN 55155-4194 Instructions on page 7 i Parcel number: 0411723110022 For Local Tracking Purposes: System status: ®Compliant ❑ Noncompliant (based on all compliance requirements) Summary Form Property Information Property owner name(s): Stephen&Katherine Poley Property address: 2605 Thoroughbred Lane,Orono, MN 55356 Property owner's address(if different): County: Hennepin Property owner phone: 952-4041413 Permitting authority: City of Orono Date system constructed: 5/5/98 Reason for inspection: Property Transfer System Description Approximately 2-1300 gallon septic tanks, 1-1300 gallon lift station and Approximately 750 square Brief system description: feet of mound rockbed as per city records. Local permit number: Number of bedrooms: 6 Design flow rate: .83 Is the system: In Shoreland area? ®Yes ❑ No In Wellhead Protection Area? ❑Yes ®No An U.S.Environmental Protection System serving a Minnesota Department Agency(EPA)Class V Injection Well?❑Yes ® No of Heath(MDH)licensed facility? ❑Yes ® No Compliance Status(Based on state requirements—additional local requirements may also apply.) Based on the information gathered and reported on attached forms,the compliance status of this system is(check one): ®Certificate of Compliance—valid until(3 years from date of report): 10/9/2010 ❑ Notice of Noncompliance-For Noncompliant systems: The reason for noncompliance is: This noncompliant system is classified as(check one below): ❑ Imminent threat to public health&safety ❑ Failing to protect ground water ❑ Not in compliance with operating permit Certification(Completed form must be submitted to the local unit of government within 15 days.) 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. Name: Joseph J.Olson Certification number: 1255 Business license name and number: Rusty Olson's soil and perculation testing Lic#810 or Name of local unit of overnment: City of Orono Signature: Date: 10/09/10 Required Attachments Inspector Complete:This Inspection Report is pages long. Check compliance forms attached: ®Hydraulic Performance ®Tank Integrity ®Soil Separation ❑Operating Permit Form(if applicable) ❑System drawing/As-built drawing ❑An assessment of any local requirements that are different from what is required on this form ®Soil Boring Logs ❑Abandonment form(if appropriate) ❑Other information(list): Upgrade Requirements(derived from 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 requited by local ordinance.!f 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. wq-wwists4-31 Compliance Inspection Form for Existing SSTS 4/4/08 r _ _ _ t Parcel number: 0411723110022 System status: ®Compliant ❑Noncompliant (as determined by this form) Hydraulic Performance and Other Compliance Compliance Issue #1 of 4 Date of observation: 10/06/10 Reason for observation: Property Transfer This form expires upon next inspection or in three years,whichever occurs first: 10/06/13 Compliance questionsicriteria:(Required) Verification Method*: (Optional) (Check the appropriate box) (Check the appropriate box) Does the system discharge sewage to the ❑Yes ®No ® Searched for surface outlet ground surface? El Performed hydraulic test Does the system discharge sewage to drain ❑Yes ®No tie or surface waters? ® Searched for seeping in yard Does the system cause sewage backup ❑Yes ®No ® Checked for backup in home into dwelling or establishment? ❑ Excessive ponding in soil system/D-boxes Do other situations exist that have the ❑Yes ®No potential to immediately and adversely ❑ Homeowner testimony impact or threaten public health or safety ❑ Examined for surging in tank electrical,unsafe covers etc.)? El "Black soil"above soil dispersal system Any"yes"answer Indicates that the system/s an imminent threat to public health and safety. ❑ System requires"emergency"pumping ❑ Performed dye test Does the system pose a treat to ground ❑Yes ®No water for any conditions deemed non- protective ❑ other. as determined by the "Yes"indicates that the system is failing to protect ground water.K"yes".describe the condition noted: "No standard protocol exists. This list is not exhaustive, m sequential order,nor does it indicate which combinations are necessary to make this determination. Certification This form is to be meted and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPGA)Compliance Inspection Form for ExMng Subsurface Sewage Treatment Systems.Observations,interpretations,and conclusions must be completed by an inspector.Completed form must be submitted to the oral unit of government within 15 days. Property owner name(s): Stephen&Katherine Poley Property address: 2605 Thoroughbred Lane Orono MN 55356 Property owner's address(if different): County: Hennepin Phone: 952-404-1413 I hereby certify that I personally made the observed",interpretations,and conclusions reported on this form and that they are correct. Name: Joseph J.Olson Certification number. 1255 Business license name and number Rusty Olsoas soil and percutaton testing Lic#810 or Name of local unit government: City of Orono Signature: f Date: 10/09/10 -11 wq-wwists4-31 Compliance inspection Form for Existing SSTS 4/4/t)6 V ct Vo l u 11:518 11110 ybL-4U 1-"I OU p"L Pai cel number: Sysmrn status. ❑Con.pliant Nancompliant ias*lIvrniner!byNo hrm) Tank IrstogrKy and Ssfatty Compliimice Compliance Issue#2 of 4 Oath of Qoserve6n: Reason for obsetveton: y`1�.':�-�.�n;1 r c '•-�,,#n 1:h1G form expires on(ffttee yGB4 r` Cctnplfanos guestiorfslcrtl aria.(Required) flet t�lttlQrt�8t#ttv3":�t3Atltxtal) _�. rchai*the a9PPMP6ffa bg . (Chock the apprapr:ate bdx,) P?ce8111e aystertr cWsist-of 8,560099a ph,, 1 my--$ Tic ss ti! lir tatairt !w? CI t'robed tank 6oitarti Do any sewage tankts)6ak belowthalr Q Yes •-Q iso Q Observ®d lour liquid level des!-or W vger;�g oths 0 -E=MI:,ed OOW! ttdion records Itties,tttarrtlty%Wch Wftge � Emmined amp's(pumped)tack Wk ark le lta. .— . L""j. Probed ouWa ankfor"buck soft" Any"yesusnsts writ trckat met the systm is fefting to protect f ggrQwrd%ww, Q Pressuiel wcuLm chaok ` Seepage pits m6ating T080..a3o may be compliant if allowe6 0 00er In grdir MMS by 10mi perm-TWnp euthority. --xO=f1OF8rd prott�Gt exists.T�wS list isnot exhaustive,in sequeniid order,icor'does if ftmYcale viltich cc-mb*oWns ' era srecassary to-ftehe Mrs dettni*Mt1bn. Safety Check Am attytrWifgenattca trate c;wts demrQW,•ta-ackW,or appeered to besG-uct:reJiy unsound? Yr.V 16No 2. Were-4ffsidenwxe We covera replaced Ina secured manner Mg.:all SOP.Ws replaced}? . Ig Yes Oto` 3. ' Wn secoWsly swess restrA t prassWL(safety pen.second oover.or ss»ty netting)—big*rs.ammiandod. ❑Yes 1 PNO G. was On 1 other SMI*/health WGL.e present? [t Yes' N� Esgsam: - l 'Syabm is-an fMM1H&)?t VWMd 1O pabric hearth and 80--'*tl/_ Cei'ii 7C>stion 'ihisfi9l�tt iato.ii�t�ornpiabd arxi>�chsd to t`ts St!,�rtary Ecrn aftns i►A7niresotai Poi!trilon Cottrei Rganaf3{fi��'CA�-Gomc!lance • ins{rsettcrhjrmmjbr•Extstirrg Subsurkm SewagerTrsatmentSyatems.abserratrona.WeITIvII81WO,attd mmol rstors must be ampl�.L.y pen mow,makdatner,orstrrvtce provider.Compleind fain must be submitted-i�ttrs 1=1 unt of government-,� n hl 13 days Ptopt rtpOmertlame(s}: Ptnperty ad rss�: _ S -/ r,K�a¢,Z�,_e �` �'` '�•c� — = . Property ownaes address Cd sift"- . Cuunty: P, Phone: ftmbyc8iW that ipemonarlyinedethe observations, tnt'arpreiatlerts,and cmwJv3ft-,s rGROMLI07 VIM f rm end,thattheyaro catrsck Names Sy U 1 yam C:sfflicetion number. t3vstaess ttgsnss tzei.�a��+.,e+b:.: �:1 I r`�vG:�.� L�•��.•�-�� <._. I 1 L.� or Nome of'loml unit of a --,----- S1Qnatt:m pate: 7 tZ`zr�•Z��„� -- s+�-}^rwissr�•r-3 i � c�mpttt�:�1nsGe�ilor dorm�crfxfs:tr�:S?'S . w r:r!uc 4 Parcel number. 0411723110022 System status: ®Compliant ❑Noncompliant (as determined by this form) Soil Separation Compliance and Other Compliance Compliance Issue#3 of 4 Date of observation: 10106/10 Reason for observation: Property Transfer This information on this form does not expire. Compliance questions/criteria:(Required) Verlflcatlon Method":(Optional) (Check the appropriate box (Check the appropriate box) For systems built prior to April 1,1998,and not ® Conducted soil observation(s)(attach boring logs) located in Shoreland or Wellhead Protection Area or not serving a food,beverage or ❑ Two previous verifications(attach boring logs) lodging establishment: ❑ Other. Does the system have at least a two-foot vertical separation distance from periodically saturated soil or bedrock? ❑Yes No For non-performance systems built April 1, 1996,or late or for rram-performance systems located in Shoreland or Wellhead Protection Soil observation does rat expire.Previous observations Areas or serving a food,beverage or lodging by two independent parties are sufficlent,unless site establishment: conditions have been altered. Does the system have a three-foot vertical separation distance from periodically saturated soil or bedrock?' 0 Yes El No For reduced separation distance systems(i.e., 'performance*systems under old 7080.0179 or 'May be reduced by up to 15 percent H allowed in local Type IV or V system under new 7080.2350 or ordinance. 7080.2400): "hyo standar/protocol exists.This list is not exhaustive, Does the system meet the designed vertical in sequential order,nor does It indicate which separation distance from periodically saturated combinations are necessary to make this soil or bedrock?' ❑Yes 0 No determination. Any no'answer ladYdOrms 6W the syssam is f&Hft to p roled grand wear. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Contrd Agenc y s(MPGA)Compliance Inspection Form for Existing Subsurface Sewage Treatment Sysiiems.Observations,interpretations,and conclusions must be completed by an inspector or designer.Completed form must be submitted to the local unit of government within 15 days. Property owner name(s): Stephen&Katherine Poley Property address: 2605 Thoroughbred Lane,Orono,MN 55356 Property owners address(if different): County: Hennepin Phone: 952-404-1413 1 hereby car*that I personally made the observations,kderprelaffions,and conclusions reported on Bis form and that they are correct. Name: Joseph J.Olson Certification number: 1255 Business license noire and number: Rusty Olson's soil and petaAation testing Lic#810 or Name of local unit o�mment: City of Orono Signature: 4� Date: 10/09/10 wq-ww1sts4-31 Compliance Inspection Form for Existing SS7S 414108 Loos of Soil Borinas License#810 Location or Project:2605 Thoroughbred Lane Borings made by: Rusty Olson's Soil and Perc testing 10/6/2010 Classification System: AASHO : USDS•USDSSCS_X_; Unified ;Other _ Auger used(check two):Hand X_,or Power__,Flight,Bucket or Probe_X_ Bench mark is top of basement concrete slab.Elv:100.00 Assumed Boring Number_1_Surface elevation_99.0_ Mottled Soil at_2.2_feet 0"-6"Dark brown loam 10yr3/2 H2O present at—X- 6"-16"Brown loam 10yr4/4 16"-28"Brown loam 10yr5/4 28"-30"Rusty brown silty loam 10yr6/3 Boring Number_2 Surface elevation_97.8 Mottled Soil at 1.7_feet 0"-12"Dark brown loam 10yr3/2 H2O present at X 12"-16"Brown loam 10yr4/4 16"-20"Brown loam 10yr5/4 20"-30"Rusty brown loam to clay loam 10yr5/4 TBM:Top of lift station manhole cover Elv:100.00 assumed Bottom of rock Elv:101.2 Original grade Elv:99.2 There is 2.0 feet of sand under the rock N �3 MA S3'd S?'O c is 1 1 Sr.< CITY of ORONO c k �y ;' �C,/ Municipal Offices Street Address: Mailing Address: Sao 2150 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal Bay, MN 55323-0066 To: The Current Owner of Address �'C' T� City Ordinance requires that onsite sewage treatment systems in Orono be inspected on a periodic basis. The onsite sewage treatment system at the above address has been inspected and the following is known about the system. A sketch of the known components of the system is available for most properties at the Orono City Hall. Imminent Public Health Threat Yes No If yes,please contact the Onsite Systems Manager at 952-249-4626 within 10 days of receipt of this notice. The septic system must be brought into compliance within 90 days. Failure to do so will result in referral to the City Attorney for legal action. System Identified as Non-Compliant Yes No If yes, system must be brought into compliance by: December 31,2007 --. December.31,2010 .. Other Septic Tank ump out Needed Yes No The City recommends the septic tank(") and/or"lif tank be-serviced and pumped out every three years, _City_xecords indicate the tank(s) were last pumped out on No C' i . The tank(s) should be cleaned through the manhole and not through the inspection pipes this allows.for-proper cleaning. Comments: Inspector: Date of Inspection Telephone(952)249-4600 • Fax(952)249-4616 www.ci.orono.mn.us o�: o ),.V CITY of ORONO CVs,', 1;� =`, - ,tib► Municipal Offices Street Address: Mailing Address: '�tOg 2150 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal Bay, MN 55323-0066 Owner: O�� Se. S I 0 Q r` Address:_ T kor O v4, Orcd L__\ . Cin•Ordinance 199 requires that each emsting 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. YSTEM CONFORMITY (1-3): 1 "CODE SYSTEM" An ISTS which meets all the location,design and construction standards of the current Orono Municipal Code. 2 "COMPLIANT SYSTEM" An ISTS which does not meet all the location,design and construction standards ofthe curtent Orono Municipal Code but does meet the three foot separation requirement,and which is not failing or an imminent threat to public health or safety. 311 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(5-10): (10 Tank inspection indicates: 5 Pumpout not needed at this time. eTank must be pumped out this year (city code requires tanks to be pumped out every 3 years. Tank was last pumped 0\K o w n ) 7 Solids accumulation in tanks is at a critical a critical level. Tanks should be pumped out as soon as possible. S System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface discharge. 9 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank at nett pumpout If tanks have not been pumped out within the last three years,they should be pumped out now. 10 Inspection pipe is located directly over tank baffle(does not give accurate measurement of solids accumulation). If tanks have not been pumped out within the last three years,they should be pumped out now. DRAINFIELD CONDITION(11-1=1): 11 field is dry,no surfacing evident 12 Some evidence of surfacing,not critical yet 13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector immediately.Repairs must be completed within 90 days. 14 Drainfield extent and condition unknown. COMaffiNTS: S J S-rc u C"D a 5 Date of Inspection Septic System Inspector Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that this report does not guarantee or certify that an e..,tisting system will continue to function properly,but is merely an opinion of the adequacy of the system under current conditions based on the available information. O COPY 0 0 CITY of ORONwr O a�r� Municipal Offices . �a Street Address: Mailing Address: U$+gYjQg' 2750 Kelley Parkway P.O. Box 66 -- Orono, MN 55356 Crystal Bay, MN 55323 0066 Owner: � �, r I � �\ Address: 2605 Thoroughbred Ln. Permit Vs: 9688 Dates: 11/14/97 Contractors: Clover Hill Co. (This is [)(] an existing system [ ] new construction) . STEM COMPLIANCE (1-3) : 1 1 Code System: Meets or exceeds current City standards in all respects relating to design, construction, and location. Appears to be operating properly. 2 Compliant System: Does not meet all current City standards for new construction, but in most respects appears to be designed, located, and constructed in accordance with previous codes and is functioning properly. 3 Non-Compliant System: System may or may not meet current City standards for design, construction, or location, but is failing to properly treat and dispose of the current input; and any system with less than three feet of vertical separation between the bottom of the drainfield and the saturated soil level. (The saturated soil level is ] or is not [ ] identified under this septic system. If the saturated soil level is not id[ tified, this classification is subject to revision.) TANK CONDITION (5-9) : 5 5 Pumpout not needed at this time. 6 Solids accumulation in tanks indicates they should be pumped out this year. 7 System is discharging to the surface. Tanks must be pumped out within 48 hours. 8 Inspection risers missing-tanks could not be inspected. If tanks have not been pumped out within three years, they should be pumped out and risers installed now. 9 Inspection pipe is located over tank baffle-can not measure solids accumulation. If tanks have not been pumped out within three years, they should be pumped out now. 10 One or more tanks are cesspools, which means the septic system is non-compliant. (The tanks are [Ior are not [ ] water tight or the condition is [ ] unknown. If the tanks are not confirmed to be watertight, this classification is subject to revision.) DRAINFIELD CONDITION (11-14) : 11 Drainfield is dry, no surfacing evident. Some evidence of surfacing, not critical yet. Repair is not required at this time. 13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector immediately. Repair must be completed within 90 days. 14 Drainfield extent and condition unknown. POTENTIAL FOR SYSTEM FAILURE: (system age and condition, soils, etc. ) : low COMMENTS: Date111 Inspection --S'�rptof ISystem Inspector Note: In the event that this inspection report is used to satisfy the requirements for a transfer of property, this report does not guarantee that an existing system will continue to function properly, but indicates the operation of the system under current conditions. Telephone(612)249-4600 • Fax(612)249-4616