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HomeMy WebLinkAboutseptic info 05/08/2009 14:20 9528733112 PAGE 06/09 t . Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN SSISS-4194 Instructions on page 7. Parcel number: For Local Tracking Purposes System status: K/1 ompliant ❑ Noncompliant (based on aN ca ce requirements) Summary Form Property Information Property owner name(s): �.} Property address: Jctw Property owner's address(if di ferenty County: P iel owner phone: 9 - Pal - -----•••_•. [ �Pe Itting authority: Date system const ted: g Reason for Inspection: w System Description Brief system description: t` V\ ,/���� Local permit number; Number of bedrooms: Design flow rate:-_C Is the system: In Shoreland area? Ayes ❑No In Wellhead Protection Area? ❑Yes KNo An U.S. Environmental Protection System serving a Minnesota Department Agency (EPA) Class V Injection Well?❑ Yes 1%940 of Heath(MDH)licensed facility? ❑ YesNo 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 onel K— C ertificate of Compliance="valfd'until(3 years from date of report): 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 8 safety ❑ Failing to protect ground water ❑Not in compliance with operating perm.: 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 sysrent ric determination of future system performance has been nor can be made due to unknown conditions during systern cortsrr:,ct,:r� possible abuse of the system,inedequIt fe mains nance, or future water usage, Name. _.=dsa �1]P� � Certification number: ----- a Business license name and number; Q_a, _ _ or Name of local unit of em _ Signature: Date: •-o.•/pp�� Gj - .....- Required Att ch•ments Inspector Complete:This Inspection Report is--��pages long, Check Comp a fors attached;&ydraulic Performance Tank Integrity Soil Separation ❑Operating Permit Form i,f applicable) rstem drawingfAs•built drawing ❑An assessmerfI of any local requirements that are different Ir what is requ rec on tris form ❑Soil Boring Logs ❑Abamonment form(if appropriate) ❑Other information(Ifkt); Upgrade Requirements(derived from Minn,Stat.6.115,55)An imminent Mreal to public health and safety rITPNS)must be upgraoso reoiacec its use discontinued wftn ten months of recoo orthis notice or wlrhtn a shoAer period If required by local oldlhance.if the systemic lading to orolecl;,roar.= water,the system must be upgraded,r+pfead,orits use discontinued wititin the time required by local ordinance,rf an exiso'ng system,s not larr.ng Is law,and has at least two Met of design sob separation,then the system need not bo upgraded,repeirad,replaced,or its use disconrrnued,nor,wrinva w.rq ig local ordinance that is more MCI. This provision does not apply to systems in shoreland areas,Wellhead Protection Areas,or those used n comp,! beverage,and lodging establishments as dellned in taw. ins sts4 31 et Compliance inspection Form for £xi9;irF SS'> l►nrt 05/08/2009 14:20 9528733112 PAGE 07109 r , Parcel number: _ _ System status: Compliant ❑ Noncompliant (as determined by phis brm) Hydraulic Performance and Other Compliance Compliance Issue #1 of Date of observation: iwi I Reason for observation: This form expires upon next inspection or in three years, whichever occurs first: Compliance questions/criteria: (Required) Verification Method": (Optional) Check the pp propriate box (Check the appropriate box) Does the system discharge sewage to the ❑YesNo round surface? Searched for surface outlet Does the system discharge sewage to drain ❑Yes KNo ® Performed hydraulic test -tile or surface waters? / Searched for seeping in yard Does the system cause sewage backup ❑Yes ❑ Checked for backup in home into dwellln or establishment? P(No ❑ 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 safetyExamined for surging In tank electrical,unsafe covers,etc.)? Any"yes"answer indicates that the system is an imminent ?r-11--! Black soil"above soil dispersal system threat to public health and safety. ❑ System requires`emergency'pumping Does the system pose a threat to ground ❑Yes 7No El Performed dye test water for any conditions deemed non- ❑ Other: protective as determined by the inspector? "Yes"indicates that the system Is failing to protect ground water. If"yes". descrfbe the condition noted: No standard protocol exists. This list is not exhaustive. -� in sequential order, nor does it indicate which combinations are necessary to make this determination. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems,Observations, interpretations,and conclusions must be completed by an inspector. Completed form must be submitted to the local unit of government within 15 days, Properly owner name(s): y�Q� Property address: Property owner's address fif different): County: _ [�.� Phone: I hereby certify that/personally made the observations, interpretations, and conclusions reported on this form and that they are correct. Name: , � a Certification number: 9�..rt Business license name and number: ,-, ^� or Name of local unit of rent: Signature: _ Date: wq-wwists4-31 Compliance Inspection Form for Existing 55T5 411108 05/08/2009 14:20 9528733112 PAGE 08/09 Parcel number: — System status: Compliant ❑ Noncompllant (as defermined)y f fs form) Tank Integrity and Safety Compliance Compliance IssuA#24&, ' Date of observation: Reason for observation: LLI This form expires on(three years): Compliance questions/criteria: (Required) VerMeation Method": (Optional) Check the appropriate box (Check the appropriate box) Does the system consist of a seepage pit', ❑Yes J+lo ❑ Probed tank bottom cesspool,dD=ell,or leaching nit? Do any sewage tank(s)leak below their ❑Yes No Observed low liquid level designed operating depth? xamined construction records If yes,identify which sewage xamined empty(pumped)lank tank leaks. 9: ❑ Probed outside tank for"black soil" Any'Ws"answer Indicates that the system Is failing to protect ground water. ❑ Pressurelvecuum check Seepage pits meeting 708.02550;may be compliant if allowed Q Other. in ordinance by local permitting authority. _ •*No standard protocol exists. This list is not exhaustive,in sequential order,nor does it indicate which combinations are necessary to make this determination. Safety Check 1. Are any maintenance hole covers damaged,cracked.or appeared to be structurally unsound? ❑ Yes' A No 2. Were all maintenance hole covers replaced in a secured manner(e.g.,all screws replaced)? Yes ❑ No' 3, Was secondary access restraint present(safety pan,second cover,or safety netting)-highly recommended. ❑ Yes No 4. Was any other safetyihealth issue present? Cl Yes' No Explain: 'System is an Imminent threat to pubilc health and safety. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations,interpretations, and conclusions must be completed by an inspector, maintainer,or service provider.Completed form must be submitted to the local unit of government within 15 days. Property owner name(s): _- Property address: Property owner's address(if different): County: ,��/��-- Phone: "_-- I hereby certify that I personally made the observations, interpretations,and conclusions reported on this form and that they are correct. Name; Certification number: 1p _ Business license name and number: U I-% I1t_ '} � or Name of local unit ver t: Signature: Date: 91, wq-ww1st't4 Compliance Inspection Form for Existing 5STS 411108 05/08/2009 14:20 9528733112 PAGE 09/09 Parcel number: -_ System status: Compliant ❑ Noncompliant (as determinedly t is form) Soil Separation Compliance and Other Compliance Compliance Issue #�30 r 4 Date of observation: .7 LV? Reason for observation: This information on this form does kot expire. - Compliance questionslcriteria: (Required) Verification Method": (Optional) Check the appropriate box (Check the appropriate box) For systems built prior to April 1, 1996,and not Conducted soil observation(s)(attach boring logs) located In Shoreland or Wellhead Protection Area or not serving a food,beverage or lodging establishment: C1 Two previous verifications(attach oring Ings) ►� stem have [I Other: 4Kp /01:tK1L_ Does the s y a e at least a two-foot .� vertical separation distance from periodically saturated soil or bedrock? 0Yes No :i For non-performance systems built April.1, � 1996,or later or for non-performance systems - �-- located in Shoreland or Wellhead Protection Soil observation es not expire. Previous observations Areas or serving a food,beverage or lodging by two Independent parties are sufficient, unless site establishment: conditions have been altered. Does the system have a three-foot vertical separation distance from periodically saturated soil or bedrock?' Yes No For reduced separation distance systems(i.e., "performance"systems under old 7080.0179 or ' May be reduced by up to 15 percent if allowed in local Type IV or V system under new 7080.2350 or ordinance, 7080.2400); No standard protemol.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?' IYes No determination. Any"no"answer indicates that the-system is failing to protect ground water. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPGA)Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems.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.a Property owner name(s): 5w_ _ Property address: --- Property owner' address (if different), �^ County: rjgPhone: -- _ I hereby cert/fy that I personally made the observations, interpretations, and conclusions reported on this form and that they are correct. Name: Certification number: � — Business license name nd nu ber: �►r[�� 5 Wer2 or Name of local unit o ver ent , Signature: — Date: .571 wq-wwists4-31 Compliance Inspection Form for Existing SSTS 4/1 inR 4� `'•�'.` CITY ®f ORONO ,a :. �►,; Municipal Offices A` A., '6 ' ' G Street Address: Mailing Address: SU 2750 Kelley Parkway P.O. Boz 66 Orono, MN 55356 Crystal Bay, MN 55323-0066 To: The Current Owner of Address ��© ' e f4l e i 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(s) Pump out Needed Yes No The City recommends the septic tank(s) and�or lift tank be serviced and pumped out every three years. City records indicate the tank(s) were last pumped out on j do a . The tank(s) should be cleaned through the manhole and not through the inspection pipes, this allows for proper cleaning. Comments: Date of Inspection —046 Ins Insnzctoi. P T, 2 7 0i�e (9,2) 249--60? ° �'$i (95 2) 2419-46-",6 _2 - o CITY of ORONO Municipal Offices Street Address: g5a-Jt49-460 O Mailing Address: g4� 2150 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal flay, 55323-0066 To Current Owner: Address: 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. YSTEM CONFORMITY 1-3 1-16 0'bi SYSTEM"An LSTS which meets all the location,design and conduction standards of the current Orono Municipal Code. 2 "COMPLIANT SYSTEM" An LSTs which does not meet all the location,design and construction standards of the current Orono Municipal Code but does mm the three foot separation requirement or two foot requjarment 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 LSTS;an LSTS located within a designated 100-year flood plain,any ISIS 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 ISIS with less than tree feet of unsaturated soil or sand between the distribution device and the limiting soil characteristics. TANK CONDITION(5-7): Tank inspection indicates: ®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 seutic tanks are numPed thronah manhole and not through white inspection Pines. This allows for the Proper cleaning. Keep water soitner and iron filter discharge out of septic system to prolong life of drainfield Ask pumper to test alarm float to verify alarm is still working in your house. The alarm warns owner that septage is about to backup into basement. 7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank. If tanks have not been pumped out within the last three years,they should be pumped out now. RAINFIELD CONDITION(8-10): 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. COWENTS: ���.�.L�J s �kS (pole off_ Date of Inspection Matt Bolterman- 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 ontify that an existing system will continue to function properly, but is mea*an opinion of theadepuacy of the system under carnal conditions based on the available information. o IRK C-ITY- of ORONO . ���� Municipal Offices l ,, Street Address: Malling Address: „ H 2750 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal Bay, MN 55323-0066 95a-49-4600 To Current Owner: Address. 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. &ysTEM CONFORMITY (1-3): 10"CODE SYSTEM"An ISTS which meets all the location,design and construction standards of the current Orono Municipal Code. 2 "COlvfpLIANT SYSTEM" An ISTS which does not meet all the location,design and construction standards of the current Orono Municipal 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 ISIS 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. 'WANK 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 requires tanks to be pumped out once every 3 years. Tank was last pumped Blake sure septic tanks are pumped through manhole and not through white inspection pipes This allows for the proper cleaning. 7 Inspection risers missing-tanks could not be inspected. Inspection risers(4"dia.pipe)must be installed in each tank. DR.ArNIFIELD CONDITION -tQ : Drainfield is dry,no surfacing evident. 9 Some evidence of surfacing,not critical yet. 10 Drainfield is satumted and visibly discharging untreated effluent to the surface. Contact the City Inspector immediately.Repairs must be completed within 90 days. CONSMNTS: Q 02— c1� a-4 S4 t�-C_ tc A 6K Date of Inspection Matt Bolterman- 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 5u=-r or certify that an existing system will continue to function property,but is merely an opinion of the adequacy o f the system under current conditions liked on the availabl' information. .� CITY of ORONO V4 T'll, y titi Municipal Offices �.,$ . �yG Street Address: Mailing Address: 2750 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal Bay, MN 55323-0066 June 15, 2000 Joseph& Catherine Botos 320 Wakefield Road Wayzata, Mn 55391 Dear Mr. &Mrs. Botos: An inspection of your septic system was conducted on June 14, 2000. A summary of the inspection is below. Septic Tank Condition 1. Pumpout not needed at this time. The septic system is a compliant system, meaning it meets all or most current City and State Standards. Enclosed is a list of licensed contractors who work in Orono on a regular basis. This list is enclosed simply for your reference in case your septic system needs maintenance in the future. Also enclosed is a fact sheet explaining your septic system and how it functions. Finally, an as-built drawing is enclosed showing the approximate location of the septic system. If you have any questions regarding this report, please contact me at the City Offices at 2494600. Re ectfully, Z s Pence On-Site Systems Manager Enclosures In the event this inspection report is used to satisfy the requirements for a mortgage or other transfer of property, be advised that this report does no guarantee or certify the existing 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. This report must be kept on the premises with the system location and pumping records. Telephone(952)2494600 • Fax(952)2494616 www.cLorono.mn.us 0 0 �' 'A N;' r = CITY of ORONO Municipal Offices Street Address: Mailing Address: 2150 Kelley Parkway P.O. Box 66 Orono, MN 55356 Crystal Bay, MN 55323-0066 Owner: Address: 320 Wakefield Rd. Permit #'s: 7488 Dates: 7/3/84 Contractors: Volkenant (This is EN an existing system [ ] new construction) . SYSTEM 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 [A or is not [ ] identified under this septic system. If the saturated soil level is not identified, this classification is subject to revision.) K CONDITION (5-9) : 5 Pumpout not needed at this time. 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 [ ] or are not [ ] water tight or the condition is 1�4 unknown. If the tanks are not confirmed to be watertight, this classification is subject to revision.) ,QkAINFIELD CONDITION (11-14) : 11 flij Drainfield is dry, no surfacing evident. 2 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: In order to confirm that your septic system meets Minnesota standards, soil borings were performed to verify a 3 foot separation between the drainfield and the seasonal water table. The separation is 3 feet and the system is compliant. Date of Inspection ep is ystem Inspe for 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) 473-7357 a FAX 4734510 CITY OF ORONO O Municipal Offices O O Post Office Box 66 Crystal Bay, MN 55323-0066 ON—SITE SEWAGE TREATIONT INSPECTION REPORT ti 9kES 0 Owner: Address: I Permit #'s:— Dates: Contractors: City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis. The on-site sewage treatment system at the above address has been inspected and appears to fall into the category checked below. (This is P" existing system I ) new construction) SYSTEM CONFORMITY (1-3): O "CODE SYSTEM11-A system which meets all the Location, design, and construction standards of the current City Codes, and which is operating satisfactorily by treating and disposing of the entire current sewage input without discharging any pollutants into ground or surface waters. 2 "CONFORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the current City Codes, but was installed according to the code in effect at the time of installation, and which is operating satisfactorily by treating and disposing of the entire current sewage input without discharging any pollutants into ground or surface waters. 3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any system which may or may not meet all the location, design, and construction standards of the current City Codes and which is failing for any reason; and any system with less than 3 feet of unsaturated soil or sand between the distribution device and the Limiting soil characteristics. (The limiting soil characteristichas or I ) has not been identified at this time. If the limiting soil characteristic has not been identi ied, this classification may be subject to revision.) TANK CONDITION (5-10): Troinspection indicates: (S� Pumpout not needed at this time. 6 Solids accumulation in tanks indicates they should be pumped out this year to help prevent future problems. 7 Solids accumulation in tanks is at a critical level. ranks should be pumped out as soon as possible. 8 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 next 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 (11-14): Dr,�ltifield inspection indicates: VDrainfield is dry, no surfacing evident. Some evidence of surfacing, not critical yet. 13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector immmediately. Repairs must be completed within 90 days. 14 Drainfield extent and condition unknown. LIMITING SITE FACTORS (slope.setbacks.etc.): POTENTIAL FOR SYSTEM FAILURE (depends on soils.water table.etc.): I&OL) COMMENTS: Date of Inspection geic 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 existing 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. This report must be kept on the premises with the system location and pumping records. WHITE COPY/Inspectors File YELLOW COPY/Homeowner