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Home My WebLink AboutSeptic System Inspections � °� 0 0 �, - =,. - � �� ,r3;� ; � CITY of ORONO � ,� � ��,. ; ,� � �� fi ',A"�`,, ��'�� '��``. r,� � l�'�� Municipal Offices '� �:��i�� ,4%' us 'ti � '� �� Street Address: �15a-a�q'�I6o � Mailing Address '��;gg0� 2750 Kelley Parkway P.O. Box &6 Orono, MN 55356 Crystal Bay, MN 55323-0066 To Current Owner: Address: � � �� C� fl�.'ft q� L—i9,tl�� 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): � 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 conshuction standards of the current Orono Municipal Code bnt 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-COb4PLIANT SYS1'EM" 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): � Tanl: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 pumped throu�h manhole and not through white inspecfion pipes. This allows for the proper deaninE. Keep water softner and iron filter discharge out of septic svstem to pro{on�life of drainfield. Ask pumper to test alarm float to verify alarm is still working in your house. The alarm warns owner that septa�e 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. DRAINFIELD CGNDITION(8-lU): � 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: �� KS �d�� r� ��P v rti r�.e ca � � - I �croS 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 dces 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 cuirent conditions based on the available information. �o� O , O CI'I'Y OF ORONO -�,.�-.- � • �� MunicipalOffices r�,, ,� �� , Street Address Mailing Address: � G'�' 2750 Kelley Parkway P.O. Box 66 'Z�y .�y'�i Orono,MN 55356 Crystal Bay,MN 55323-0066 kESHO To: The Current Owner of Address 2140 CARRIAGE LANE 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 954-249-4626 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 No ompliant Yes No If yes, system must be brought into compliance by: December 31, 2007 December 31, 2010 Other Septic Tank(s) Pum out Needed Yes No The city recommends the septic tank(s) and/or lift tank be serviced and pumped out every three (3) years. City records indicate the tank(s)were last pumped out on �- !3-O� The tank(s) should be cleaned through the manhole and not through the inspection pipes, this allows for proper cleaning. Comments: ��e� Inspector: Date of Inspection: �r O� Telephone (952) 249-4600 • Fax (952) 249-4616 www.ci.orono.mn.us j O \\\\ '� '�' \\ � 0 ��` �`� {r� - �' CITY of ORONO �';� ,�1 h,'�-" ';�`.'_}~ ,�,ti'� Municipal Offices ��;�'�� ,•.�_'1�•: r;,�,:�� i� Street Address: � ' �i� Mailing Address: ��9��g��i� 2750 Kelley ParkwaY P.O. Box 66 � Orono, MN 55356 Crystal Bay, MN 55323•0066 To Current Owner: Address:_ � L/ (,l L�'(I'; c �.Q �n City Ordinance 199 requires that each existing on-site sew�age treatment system in Orono be inspected e��ery two years. The on-site sewa�e treatrnent system at the above address has been inspected and appears to fall mto the categories checked below. SYSTEM CONFORMIT'Y 1-3 : � 1 "CODE SYSTEM" An ISTS which meets all the locazien,desi�and conswction standards of the current Orono�[unicipal Code. 2 "COMPLIANT SYSTEM" An ISTS which does not mzet all the location,design and construction standards of the current Orono Municipal Code but does meet the three foot separation requiremer,t or t�ro foot requirement for systems installed 1996 or zariier,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 conswction standards of the current Orono Municipa!Code and which is failing for any reazon;and any[STS with less than three feet of unsaturated soil or sand bet�veen the disvibution device and the limiting soil:haracteristics. TANK CONDITION(5-7): � Tank inspection indicates: � Pumpout not needed at this time. � Septic tanks must be pumped out this year (ciry code requires tanks to be pumped out o�ce even 3 years. Tank was last pumped )_ Make sure septic tanks are aumaed throu�h manhole and not through white inspection nipes This allows for the proaer cleanmg. Keea water softner and iron filter discharge out of seatic s��stem. 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. DRAINFIELD CONDITION 8-10 : O 8 Drainfield is dry, no surfacing evident. 9 Some evidence of surfacing, not critical yet. 10 Drainfield is saturated and visibly dischar�in�untreated effluent to the surface. Contact the Cin Inspector immediately. Repairs must be completed within 90 da�s. COMMENTS: D t�'.�•�.1 c� ( o�S O k_ _ P �� S e +�. L fi�i�1�5 , Cr\enc� �-`.�c oc1 Sec�c� �-qc�� U �� 0.� Date of Inspection Nfatt Bolterman - Septic System Inspector Note: In the event that this inspection report is used to satisfy the requirements for a mort;a�e or other transfer of propem�,be ad��ii;d that this report does not guarantee or certify that an existin�system will continue to function properly,but is merely an opinion ofthe adequacy of the system under cur:nt conditions based on the available information. Telephone(952)2-�9-4600 • Fax(952)249-4616 w�.ci.orono.mn.us 07/19/2611 21:33 7634975011 �� PTESTINGINC PAGE 02/09 . � `\ �C� � �' . , Minnesota Pollution �� pliance inspe�taon Form A'�``�'�::•-�__- Control Agenty ....- E u uirface S�wage Treatmen�t Sys�ems (SSTS) 520 Lafayette Roac!North 5t.Paul,MN 55155-419+1 Doc rype�Complianco and��forcement 9nstructions on paga 6 Summary �o�rm (Completed form must be submitted to the locai unit of government within 15 days.) Parcel number. ,_„^ .,.___,__ _..� System status: For Loc�l Tracking Purposc�s:� �Compliant [] Noncomp►iant (based on all comp►iance requlrements) Property Information Property owner name(s): �G a��\�I► �.I.�t�?�I Property owner phone: ��'t,.'7d,C) -�'?�� Property address: a,�-1��1.1�r ta'� L�a� rG. �v�C, _. _ Property owner address(if dlffarant): _ __„�_�,_.,..,� Cauniy� t-1�i�-t�1�k�1 Permitting authority: ,,.,��p�b�O�c? D�te system constructed; al O 0 I _ Reaeon for inspection; �D�p��(^�P�Y3�!IS _��_'_ . System Desc�ription ��►a�,.�,� �►��.� l�."¢o�� B�ief system description: o-�loon�l,S��-�►e� �t�+��^'� + 3q� �-+a�y�'(i o'�s��►_�'P-v�v�w�-�� P�'P�• �. Local permit number: Number of bedrooms: 5� Design i�low rc�te: 7 c7 .� Is tho system: In Shoreland area? []Yes � No In Wellhead Protection Area? ❑Yes �1 No An U_S_ Envlronm�ntal Protection System serving a Minnesota Department Agency(EPA) Class V Injedion Well?�Yes I� No of I-leath (MDH)licensed facility? ❑Yes � No C0111p1i811C2 StdtUS(eased on stete r�quirements-additionel local requirement;s may alsa app/y.) Besed on the infoRnatian gath�red and reported on atkached forms,the compllance status of this system is(chock one): �Certificate of Compliance-valld until(3 years from date af Oaport)� [� IVotice of Noncomplianne-For Nvncompliant syst�ems; The reason for noncompllance is: ...,...Y.,_�., This noncompl9ant system is classified as(check o�e balow): ❑ Imminent threat to public health&safety ❑ Failing t�protect ground water ❑ Not in compli�nCe with operating permit Certif9catian 1 her�by ceriify that all the necessary informatlon has been gafhered tn detennine the compllance status vf this sysfem.No dete►m�nBGvn of futur�system perfo►mance has been nor can he made due to unknown condiflons during systom construction, passible abuse of the system, /nedequate mainfenance, or future water usage. Neme: �t'%V _.,,,,,;�_sr�.�t�5 Certification numbe�: (0�7 Buslness Ilcense name and number: S-4 -��_I�LJLz_��C . �.�L' � �` 39'�-�N�'?to3-`�`D7� �S��c+ or Name of local unit of government: . �__ ____ __�.r._, Signature: _ Date: _,___ Required At�achments � Hydraulic Performance �Tank In�tegrity [] Operating Permi�Form (ff applicable) � Soil Bonng Logs � �oil Separation (� System drawing/As-bu(It drawing ❑ Any local requirements that are different from what Is required on this foRn ❑ Other inforhtation (list): ,,,,_ �. Upgrade Rpquitements (derlved from Minn. Stat.§115.55J An lmmJnent fhr9et to publlc health and satety(ITPHS)musr Ge upgreded. .raplac�d,or its use discontinued wlthln ten months of recelpt of thls nofice.or wifhin 9 shorterper�ad if required by local ordlnance.IF the system is failin.q to protect ground water, the sy&tem must bo upgraded, �placed,orlls uso disconfinued wiHtin Ihe Bme required byloctal ordin�+nce.!f en existing syst�m Is not falling�s defined in lew,end has at IeasP!wo feet of of�islgn so�7 separation, then the system noed not be upgraded,rapell�d, repiaced,orits use discontJnued,notwlthstanding any local ordinancQ that is more str�et. Thls provisia��does not apply to systems In shoreland areas, We1lhEad Profe�tlon Areas,or tHose used!n connection with food,l�eve►'ag�, and lodging esteblfshments as defined in lew. 07/19/2011 21:33 7634975011 SPTESTINGINC PAGE 63109 Parcel number: �, , System status: �Compliant ❑ Noncompliant � (as det`ertnfned by tl�is farm) Hydraulic Performance and O#her Compl�ance� Compliance Inspection Form for,�xisling SSTS Compltiance 15su� #1 0#4 Date of observation: �- � 1 � ��._,_,� Reason fnr observation: ��-( ��w.i� .4�'�'� 7his form oxpires upon next Inspectibn or in three years,whlchever occurs first: _ Compliance questions/criteria: (Required) Verification Method': (Optional) (Check Ihe eppr�priate box) _.,_,.,� (Check the app►apriate box) Does the system discharge sewag�to the (]Yes � Nv � Searched for su�Face outlet 1J0 c�round surFace? _ ,. ❑ PerFormed hydraullc test Does the system discha�ge sewage to drain ❑Yes ❑ No tlle or surface waters? �I Searched fo�seeping In yard �N O Does the system cause sewage ba�kup []Yes � No � Checked fOr backup in home into dwelling or establishment? _ _ � Excessive ponding in soil system/0-boxes hl0 Do other situations exist that have the ❑Yes �Na 0 }iomeowner testimony po#ential to immediately and adverseVy impact or threaten publlc health or safety ❑ Examined for surging in tank (elect�ical, unsafe covers etc. ? [�] uBlack soil"above soll dispersal system �.6� Any"yes"answpr►ndlcat�a that the syst�m Is an imminen� th►eat to publlc hgalth and safety. ❑ 5ystem requlres"emergency"pumping �------ �] Performed dye test Doas the system pose a threat to ground ❑Yes � No ❑ Other, 1��!��I,l� �(¢�'4.5�C-1•�4 water for eny conditions d�emed non� �protec�ive as determinpd by the ins eeto� �,�.1�.y�b�'�. "Ye�"indicates thet tl�e sysiem i�failing to protact ground watei If"yoes'; descn6e tho condition nntod: "No standard profocol exisfs. This lis�is nof oxhaustive, ___..,_._ in sequenfia!order, nor does if indicate which combinations are necessary b make this determinafion. Certificafiion This form is to be completed and attached to the Summary Form efi the Minnesota Pollution Control Agency's(MPCA)Compliance Inspectian Form for Exlsting Subsurtace Sewage Treatment$ystems.Observatfons, interpr'etatians,and conclusions must be cvmpleted by an lnspector. Completed form must be submltted to the local unit o�P government within 15 days, Property owne�name(s): �l,�'„��,f��l-�t�9�� ,_. .,_ Property address: a�_t� �+�t �'�,�� L�.�d�� Property owner's address pF dlr�arent): � ,.,_ _ .� County: '� � �%''�,4„S� --- Property owner phona: lo lZ-- 'J'ZO --� t.4 7�.�� - 1 hereby certify that 1 personally made tife obseNatfons,interpreiafions, and conclusions reported on Niis form and tha�ftiey are conect Name: 5��;,!,;(3_, S L1��_5��'QS Certiflcatlon number: loa n Business license name and number: S ��''`��1�1� 1�.1 L � , 1..�C. �'?t�!-�__ 1°�2�=�J° �'3_��A+� or Name of local unit o'f govemment: ,. , Signature: '��-�`� �,,.�'?9 _,,-._"-�, _,.,.. D�te: -� ��Q�.� , ., .. .--.- .-- .�. �ni .�nn onrl G[7 OOt.I . TTY 6F�_OC'!_C79��.r flAfL�C7.�0.LA . Aveilahla in olhnmePi�ia fn��ne4e 67119I2011 21:33 7634975011 SPTESTINGINC PAGE 64169 JUI"18'I�I 09:47a Elmer J.Petersc�r�Cu, 763-�7�•7217 p,1 'Tan1� Re�ox�t Date: ��'ly �5,2011 �lmer J. Peterson. Ca. i�9�1. T�a�te Ave. IJcJ�.no, MN ��.g2�, �'llone rGg-97Q-2�.�2a F1X 76�-�72-721�7 1��PCA License#� 219 , s�tt VVinlon ?.140 Carriage L�no Wayzai�, MN 55391 B��s: o�r i a�r rl�1�{ C��,�7aCltY: 2-1000 Gallon TenkS # of'l,anks: z _ T�rpe of Ta.n,lty_ Cancr�te zooa Gal.l.ons: . 11��arh.ol�s t� Cir'ade: YFS / IrTf) Comments: On July 15,�011, Eimc�J. Petefson Co. Pump�d Tanks. Fitter in 2"tl Tank. No Cracks or Wstef L�ak�at That Time, NOTL;This is ot��y a.tank xeP�rt. This in not a cotnPli�nce inspection for Uoin.t of sale not dc�cs it repl.a�r��compliance ins�ectiQn. T.icensc � �19 07/19/2011 21:33 7634975011 SPTESTINGINC PAGE 05/09 Jul 18 11 09;47a Elrriei J,Pelr�fson Co. 763-97�-7217 r.2 PArcel numbP� __ System stat�rs; �Compllani ❑Noncornpliaht (as�ecermlrre�l by thls f�orm) Tank Int�griiy and Saf�ty Complwance -Compliance lnspec�ion Form for E�rfsting SSTS Compliance Issue#Z af 4 i�atP,of eb�ervgilon, 7��$�� . _ Rcason Fot obseNation: Palnt oi 5ale � Thls Form expires on(three yeao�): ��4 Com�liance questionslcreteria: (Required) uerlticetian Methfld"":(Optional) [Gheck the sprol;oprlel'e box (Check Fhe eppropnete box) Daes the system cunslst of e seep�ge pi�', ❑Yas Q No ❑ prohed tank bottam cess op ol,drYwell,,ocleachin 'Y? ❑ ob6erved bow liquid level Do any sewage tank(a)leak helaw their �]Yes �No designed operatln de th? Q Eu�mined construction recards If yes, Iderrtify whach � Examined empty(�umped)tank sewage tank leaks, „__.. ❑ Probed outalde tank For"biack soii" Any"yes"answerfndlcates t1rAt#Ite�sterry 1s tblNrt�to protect grourtd water. ❑ Pressuralvacuurn chr�ck ❑ Othe.r „ ' 9eepage prts me�Cing�ag0.2550 m�ay b�compllant if alFoWed in o�dlnance by loeal permittSng eutha�ity. ".No stendaror/aruMc�of c�xists. 1'his Us!ia not exheuaNve,in sequentiel oMer,nor does it b?�Jcalo wh�ah combina6vns ar�nacessary ta mak�fh�;detennrnatrnn. Sa�Fety Check 1, Are m�lntenanoe hole cw�rs damaged,ct9ciced,of�+pP�red to be 5truc�urally unsound? 0 Y�" �No 2. Were malt�tzn�nce ho►e m��rs repl�ced In a socured manner(e.d.,scre�vvs raplaced)? [�Y� ❑No' 3, Was secondary access resb'aint present�safety pan,second otivar, o�5afe'ly nottlng)–highly recornmended, �Yes Kl�No 4, Are o1he�sa(ehdheafth issue preAerd? ❑Ycs• QQ No E�i�ln�, .�.... . .... -- -- °System Is an Fmminent thl�at to pudlle he�alrh aod saf�ry. �@11`I�IC$��011 Thls}arm is to be comp�p�d and ath�Ched to�the Summary Fo�rn o!Ihe MinnesoCe�Pollutlnn Corrhol AgeRcy'�(MpC�t)Gompllan�e Inspection Form fhr Exlsting 3ubsurface sewage 7reatment 5yst�rns.Obsenr�l�ons, interprelatlnns,and conclusion6 muse be campleted by an Inspectar, maint8iner, or ssnrice provid�ar.Campketed Fortn must bc submitted te thQ local uni#of gaver�mentwithin 15 days. Prope�ly awner name{s�; Scott Winto� � Properry address; 2140 Gar�iage Lane Wayzata,MN 55391 � Prope�/owne�s eddres5 (li d{RerEru): CGunty: I-lennepin Propel'ty awner phone; 952-478-6291 `� 1 here6y ccrt(fy�hat�personapy mede ff�e obsarvatrons,in0e�,o►etations.and crortelusfons reported on this forrn and that thr�y are correcf. �lame; James Qnapgelmann Ceriificatlon number; Bu�lness license nema�nd number; Elmor J.Peterson Cc�. Llc�ns�218 ��,w ,_„�,.,T or Name of loc��y�gf go��rnrttent; „_ M. . ...---•— � Dato: 7�15111 Signs�ture: �,� _. - ---�---- ✓� www.pca.state.mn.us � 651•296�63� • 800-657-��4 - 1'TY 651-282-5332 0�AL1a657-3B64 - Avnllable in al�ernn�iv�formflts wq-wwlsks�-3'1 • �t/1�3ld9 PCoe 3 of 8 67119/2011 21:33 7634975011 SPTESTINGINC PAGE 66/99 Parcei number; �,_ System status: � Compliant ❑ Noncompliant ��""�� (as defermined by this form) Soil SaparatOdn C�ompliance and Olher ComipM�ance , Compliance Inspection Fo�n for Existing SSTS Compliance Issue #3 of 4 Date of obseivatlon: 7 � 1 1 � o��f 1 Reason far obsen►atfon: 'P�O�Q��1�'��5�('r�� ^�^,_ This informeNon on this form does not expire. Compllance questiot�s/criterla: (Requlrec� Verification Method**: (Optional) (Check rhe��dropriete box _�._,.� (Check the appropriate box) Fo�systems built prior to Aprll 1, 1996, and not � Conducted soil observatlon(s)(attach boring logs) located in 5horeland or Wellhead i'rotection Area or not serving a food,beverage or ❑ Two provious veMflcations(attach bvring logs) lodging establishment: ❑ Other: aoes the system have at least e two-foot �~� vertical separation dlstance f�om peiiodir�lly — saturated soil or bedrock? ❑Yes ❑ No For non-performance systems built April 1, ��,,,.._��x 1996,or later or ivr non-perFonnance systems Soil obsorvation does not expine.Pravious abseroatlons located in Shoreland or Wellhead Pratection Areas or serving a food, b�verage or lodging by two independent parties are sufficierrt,unless site establlshment_ condltions have been altered. Does the system have a three-foot veRlcal separ�tion distance from periodi�ally saturated soil or bedl'�ck?* Yes ❑ No Fo�reduced separation distance systems(I,e., "performance"systems under old 7080,0179 or " May be►educed by up b 15 percent If ellowed in local Type IV or V system under new'�080.2350 or o►tlinance. 7080.2400): *'No standard protocol exlsts. TI7is list is not exhaustive, Does the system moct the designed vertical fn sequenfial order, nor does it indlcate which separation distance from pehodlc�lly saturated combi�afions ar�necessary to make this soil or bedrock?' �Yes � No determinaf.ion, Any`"no"answer indicates that the system Is faflfog fio protect ground wat�r. Certificafiion This form is to be completed and att�Ched to the Summary Form of the Minnosota I�ollutlon Control Agency's(MPCA)Compllance Inspection Form for Exl�ting Subsurtace Sewage Treatment 3ystems.Observatlons, interpretatfons, and conclusivns 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): 5 Lq��,�,/_� ,._,,., ...- Property address: 2l 1�1� C., �1'L�� •�A ' _ �'�4.�o -..,,. •..• —_.._,_ ,....... Property owne�s eddress (it'd��nrent); _ , County: �'�}�,�_��_� Property owner phone: �p6L" �a 0 ^ !+ l,0 _�_____,.,_,_ 1 hareby certlfy that 1 persanally made thQ observabons, interpretatfons, and concluslons reported on tfi/s fom►and that they ere carrect. Name: , ��V�G�..� �. ,SL�-11�11��5 �__.___ Certitication number. (��►� �,,,,,�„�, Business Iicanse name and number. 5-4' ;{�'S��.1 L:��I,.�_,�_,L'�'� 3`�� '�I�..3.-�► Q123�Se�^, or Name of local hi� t of gover�nment• _„� ,:_. �. - Signature: G��'��'. ,� "� ,_ � _ Date: �LS�...a.J�l--.__..�... .�. '_' _�' '�� ...... ..� .... rr�..�� n� e�� ...nnn cC�iOc� _ A.�.il.l.l.......Ir.....�w....t........�. 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 Enforcement 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 Unit of Government(LUG)and system owner within 15 days System Status System status on date(mm/dd/yyyy): 6/15/2018 ® Compliant— Certificate of Compliance [1 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 permit/monitoring plan requirements(Compliance Component#5)—Noncompliant Property Information Parcel ID#or Sec/Twp/Range: Property address: 2140 Carrige Lane, Orono — _ Reason for inspection: sale Property owner: Helen Henson Y—_ Owner's phone: 952-923-1598 or - — Owner's representative: -- - Representative phone: Local regulatory authority: City Regulatory authority phone: -- ---- ------- Brief system description: 2_1300_2al septic tanks and a_gravity trench system Comments or recommendations: Certification I hereby certify that al/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 futu - water usage. Inspector name: Josh Swedlund Certification number: C1659 Business name: Sewer Se Inc License number: 2502 Inspector signature: Phone number: 952-873-3292 Necessary or Lo lly Required Attachments ® Soil boring logs ® System/As-built drawing ® 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 • 3/16/12 Page 1 of 3 Property address: 2140 Carrige Lane, Orono Inspector initials/Date: JS j 6/15/2018 • (mm/dd/YYYY) 1. Impact on Public Health -Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharges sewage to the ❑ Yes ® No ® Searched for surface outlet ground surface. ® Searched for seeping in yard/backup in home System discharges sewage to drain ❑Yes ® No ❑ Excessive ponding in soil system/D-boxes the or surface waters. — -- ❑ Homeowner testimony(See Comments/Explanation) System causes sewage backup into ❑ Yes ® No ❑ "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. ❑ 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, ❑ 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 allowed in local ordinance. Sewage tank(s) leak below their ❑Yes ❑ No ❑ Observed liquid level below operating depth designed operating depth. ® Examined empty(pumped)tanks(s) If yes,which sewage tank(s) leaks: 0 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. ❑ Other methods not listed(See Comments/Explanation) Comments/Explanation: 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. ❑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: 2140 Carrige Lane, Orono Inspector initials/Date: JS j 6/15/2018 • (mm/dd/yyyy) 4. Soil Separation —Compliance component#4 of 5 Date of installation: 7/13/2001 ❑ Unknown Verification method(s): (mm/dd/yyyy) Shoreland/Wellhead protection/Foodmm/d beverage Soil observation does not expire. Previous soil lodging? ®Yes ❑ No observations by two independent 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 ® 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 drainfield) Drainfield has at least a two-foot vertical I ❑ Unable to verify(See Comments/Explanation) separation distance from periodically ❑ Other(See Comments/Explanation) saturated soil or bedrock. ------ --__ ----_----�---Non-performance systems 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, 1-14"10yr 2/2 sandy loam beverage, or lodging establishment: Drainfield has a three-foot vertical 15-42" 10yr 4/4 sand separation distance from periodically 43-62" 10yr 4/6 sand saturated soil or bedrock.* No Redox "Experimental", "Other", or `Performance" ❑ Yes ❑ No Indicate depths or elevations systems built under pre-2008 Rules; Type IV -- � — -- — — or V systems built under 2008 Rules7080. ( A. Bottom of distribution media I 22" 2350 or 7080.2400 (Advanced Inspector — License required) B. Periodically saturated soil/bedrock i over 62" Drainfield meets the designed vertical separation distance from periodically C. System separation over 36" saturated soil or bedrock. ---------._.---- ------.._----._..___.--------=---_.-----_---- D. Required compliance separation* 36" Any "no"answer above 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 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 O eratin Permit requirements been met? ❑Yes ❑ No b. -Is the required nitrogen BMP in place and prpperly functioning? I Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(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 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 shore/and 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 -QI1-10 CGrrio , e L v Rog ci 3 3 °J L. Q C We I/ 0 Nouse ', Dec K Inv on "(Sso a io" rgve!(eS$ p pe : o YS 4o n feplUce me '-t. Area A 8 T, 34' 63' Ta 5a' 73, 1 - Zi /vyX of/Wce 7 ' - 69_ /0 Y o:A I 7-17-0 1