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Nov 0714 10:47a Joseph Olson 763-498-8290 p.2 a Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems St Paul,MN 55155-4194 (SSTS) Doc Type:Compliance and Enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: requirements and attached forms—additional local requirements may also apply. NOV 13 ?014 Submit completed form to Local Unit of Government(LUG)and system owner i within 15 days ;ITYOFOWW System Status System status on date(mm/dd/yyyy): 11/6/2014 ® 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 (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 perrnitimonitoring plan requirements(Compliance Component #5)—Noncompliant Property Information Parcel ID#or SecJTwp/Range: 3211823440018 Property address: 3220 Watertown Road, Orono,MN_ Reason for inspection: Property Transfer Property owner: Beidget Wortman Owner's phone: 952-456-2010 or Owner's representative: Representative phone: Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 2-1300 gallon septic tanks,1-1300 gallon lift station and 630 square feet of mound rockbed.per city Brief system description: records Comments or recommendations: The trees on the existing mound system must be removed. Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determinafion 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: Joseph J Olson _ Certification number: 1255 Business name: Rusty Olson's Soil&Pere.Testing License number_ 810 Inspector signature: ���-� '� Phone number. 763498-8779 Necessary or Locally Required Attachments E Soil boring logs Z System/As-built drawing ❑Forms per local ordinance ❑ Other information (list): www.pca.state.mn.us 651-296-6300 • 800-657-3864 TTY 651-2a2-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 1124112 Poge 1 of 3 Nov 0714 10:47a Joseph Olson 763-498-8290 p.3 w Property address: 3220 Watertown Road,Orono,MN Inspector initiafs/Date: J.O.11/06/14 1. Impact on Public Health—Compliance oomponerrt#1 of 5 Compliance criteria: Verification method(s): System discharge sewage to the ❑Yes ®No ® Searched for surface outlet round surface. ® Searched for seeping in yard/backup in home System discharge sewage to drain We ❑Yes ®No ❑ Excessive ponding in soil systeml0-boxes or surface waters. ❑ Homeowner testimony(See CommeriWaplanation) ❑ Tiack soil'above soil dispersal system System cause sewage backup into ❑Yes ®No dwelling or establishment. [I System requires"emergency"pumping C] Performed dye test Any"yes"answer above indicates the system is an Imminent Threat t0 Pub/ic Health and Safety. ❑ Unable to verify(See Comrnentsllwxplanaffon) ❑ Other methods not listed(See CommentslExplanation) Comments/Explanation: 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 ❑ Examined Tank Integrity Form(Attach) compliant if eftNed in local ordinance. ❑ Observed liquid level below operating depth Sewage ta*s)leak below their []Yes ®No ® Examined empty(pumped)tanks(s) des' red olLerating depth. If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil" Any`fires"answer above indicates the ❑ Unable to verify(See Commen&ajoraneflon) system is Failing to Protect Groundwater. ❑ Other methods not listed(See Comn*nts(Expl9nadon) Com ments/Explanation: Alben Septic Service pumped the tanks 3. Other Compliance Conditions—Compliance component#3 of 5 a. Maintenance hole covers are damaged,cradred, unsecured,or appear to structurally unsound. ❑Yes` O No []Unknown b. Other issues(electrical t etc.)to immediately and adversely impact public health or safety. []Yes* O 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.pcastate.mn.us - 651-296-6300 - 800457-3864 TTY 651-2112-5332 or 800-657.3864 - Avaitable in aitemative formats wq-wwists4 3f . 1124112 Page 2 of 3 Nov 071410:47a Joseph Olson 763-498-8290 p.4 IL Property address: 3220 Watertown Road,Orono MN Inspector initials/Date: J.O.11/06/14 4. Soil Separation--Compliance component#4 of 5 Date of installation: 5/11106 ❑ Unknown Verification method(s): ShorelandhNellhead protectionlFood Beverage ©Yes ®� Sall observation does not ex ire.Previous soil Lodging? observations by two independent parb;Ds are suf Beni; Compliance criteria: unless site condWons have been altered orlocal For systems built prior to April 1, 1996,and El Yes ❑ No requirements differ. not located in Shoreland or Wellhead ® Conducted soil observation(s)(Attach boring logs) Protection Area or not serving a food, ❑ Two previous verifications(Attach boring logs) beverage or lodging establishment: ❑ Not applicable(Holding tank(s),no drai dW4 Drainfield has at least a two-foot vertical ❑ Unable to verify(See ComraenteExptanation) separation distance from periodically ❑ Other(see CommenwExplane6m) saturated soil or bedrock. Non performance systems built April i, ®Yes ❑No CommentslF_xplana6on: 9996,or later or for non-peftmance systems located in Shoreland or Waffhead Protection Areas or serving a food, beverage,or lodging establishment.- DraMeld has a three-foot vertical separation distance from periodically saturated soil or bedrock.` '1=xpenmentar, `Other; or `Performance" [:]Yes ❑No Indicate depths of elevations systems built under pre-2008 Rules,•Type IV or V systems built under 2008 Rules(7080. A. Bottom of dmtnbution media 10D.3 2350 or 7080.2400 (Advanced Inspector License required) B. Periodicafly saturated soWbedrock 97.3 Draintield meets the designed vertical C. System separation 3.0 separation distance from periodically saturated soil or bedrock. D. uired com liance aration• 26 Any"no"answerabove 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 Practfce(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 O rami Permit requirements been met? Yes ❑No b. Is the required nitrogen BMP inlace and ro ri functions ? Yes No Any"no"answer indicates Noncompliance. Upgrade Requirements(Minn. Stat§115.55)An imminent threat to public health and safety(!TANS)must be upgraded,replaced,or its use discontinued wWn ten months of receipt of this notice or within a shorter period ff required by facet onfxianoe.if the system is falling toprotect ground water,the system must be upgraded,replaced orits use discontinued within the time required by local ordinance.ff an existing system is not failing as defined in law,and has at least two feet of design sW separation,then the system need not be upgraded,repaired,replaced,or its use discontinued,notwithstanaft any local ordinance that is more strict This pmwsioa does not apply to systems in shmakind areas, WeMread Protection Areas,or Nose used in connection with food,beverage,and fudging establishme is as defined in law. www.pca.state.mn.ts - 651-296-6300 - 800-657-3864 - TTY 651-287-5332 or 800.657-3864 Available in attemative formats wq-ww1sts4-31 - 1124112 Page 3 of 3 Nov 0714 10:48a Joseph Olson 763-498-5290 p.5 Logs of Soil Borings License#810 Location or Project: 3220 Watertown Road Borings made by: Rusty Olson's Soil and Perc testing 1117!2014 Classification System: AASHO ; USDS•USDSSCS X ; Unified ; Other Auger used (check two): Hand_X_,or Power , Flight, Bucket or Probe—X— Boring Number_1_Surface elevation_100.6 _ Mottled Soil at—2.0_feet 0-16" Fill in original soils 16"-32" Dark brown loam 10yr312 H2O present at X 32"-40" Brown loam 10yr413 40"-48"Rusty brown clay loam 10yr5/4 Boring Number–2—Surface elevation_99.1_ Mottled Soil at 2.6 feet 0-8" Fill in original soils 8"-16" Dark brown loam 10yr3/2 H2O present at—X- 16"-32"Brown loam 10yr4/4 32"-40"Brown ioam 10yr5/4 40"-48" Rusty brown loam 10yr514 TBM:Top of garage slab Elv-100.0 assumed Bottom of rock bed Elv.-100.3 Original soil under the rockbed Eiv.-99.3 There is 1.0 feet of sand under the rockbed Nov 071410:48a Joseph Olson 763-498-8290 p.6 r, 73. w c 1 x i G� >a Y jig. 181 zzr72 o ft j 'Ul 'cam 'tu