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Home My WebLink About2013 - MPCA compliance inspection form Minnesota Pollution Compliance Inspection Form c Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155-4194 - (£c- Doc Type:Compliance and Enforcement Kt- For local tracking purposes: Inspection results based on Minnesota Pollution Control Agency(MPGA) 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): 7/2/2013 ® Compliant— Certificate of Compliance n 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: 03-117-23-34-0015__ Property address: 2060 Weber Hills Road, Orono, Mn 55391 Reason for inspection: Property Transfer Property owner: Wells Fargo Bank, NA Owner's phone: _ or Owner's representative: Mark Representative phone: 952-915-2222 Local regulatory authority: City of Orono Regulatory authority phone: 952 249-4600 Brief system description: 2 Septic Tanks, Lift Station, Pressurized Mound Comments or recommendations: Certification 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. Inspector name: Dale Denn Certification number: 3226 Business name: George' Exc License number: 3368 Inspector signature: '# .� . Phone number: 612 310-7887 Necessary or Locally 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 I- Property address: 2060 Weber Hills Road,Orono,Mn 55391 Inspector initials/Date: djd 17/2/2013 (mm/dd/yyyy) 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 ❑Yes ® No 0 Excessive ponding in soil system/D-boxes the or surface waters. -- CI Homeowner testimony(See Comments/Explanation) System causes sewage backup into ❑Yes ❑ No 0 "Black soil"above soil dispersal system dwelling or establishment. 0 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: Home not inhabited. Unable to verify previous sewage backup into home. 2. Tank Integrity—Compliance component#2 of 5 Compliance criteria: Verification method(s): System consists of a seepage pit, ❑Yes ® No El Probed tank(s)bottom cesspool,drywell,or leaching pit. 0 Examined construction records Seepage pits meeting 7080.2550 may be 0 Examined Tank Integrity Form(Attach) compliant if allowed in local ordinance. CI Sewage tank(s)leak below their ❑Yes DI No Observed liquid level below operating depth designed operating depth. 0 Examined 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: Tanks are solid, preformed concrete with baffles and solid bottom. Unable to verify any tank leakage issues. 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 t• Property address: 2060 Weber H ills Road, Orono 55391 Inspector initials/Date: djd1 7/2/2013____ (mm/dd/yyyy) 4. Soil Separation—Compliance component#4 of 5 Date of installation: 6/26/1995 _ _ ❑ Unknown Verification method(s): (mrnfddiyyyy) Shoreland/Wellhead protection/Food beverage Soil observation does not expire. Previous soil ® CIlodging? 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 I ❑ Yes ❑ No ❑ Conducted soil observation(s)(Attach boring logs) not located in Shoreland or Wellhead ❑Two previous verifications(Attach boring logs) Protection Area or not serving a food, beverage or lodging establishment: ❑ Not applicable(Holding tank(s), no drainfield) Drainfield has at least a two foot vertical ❑ Unable to verify(See Comments/Explanation) separation distance from periodically ® Other(See Comments/Explanation) saturated soil or bedrock. Non-performance systems built April 1, ®Yes ❑ No Comments/Explanation: 1996, or later or for non-performance County Septic System Inventory File stating that height systems located in Shoreland or Wellhead Protection Areas or serving a food, above water table is 3 feet. beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* "Experimental", "Other'; or "Performance" I ❑Yes ❑ No Indicate deaths or elevations systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soiUbedrock Drainfield meets the designed vertical C. System separation 36 separation distance from periodically 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 Operating Permit requirements been met? ❑Yes ❑ No b. Is the required nitrogen BMP in place and properly functionin•? 0 Yes 0 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 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 f• SEPTIC SYSTEM INVENTORY Site Address: 2060 Webber Hills Rd PID: 0311723340015 Owner Name: Kerry R. Ignatius Owner Address: 2080 Webber Hills Rd Wayzata MN 55391 Building Type: residence Installer: Date of Permit: 5/17195 E.J. Peterson Co. System Type: mound QRS Designed for. 4 In Musa?: Yes Moreland?: YES SEPTIC COMPLIANCE INSPECTION Compliant _ Report Date: Expires: Non-Compliant?: Report in Street File?: SPECIAL NOTES Site Address: 2060 Webber Hills Rd 05/22/08 2008 Septic Maintenance Report Letter Sent 03/16/09 2009 Septic Maintenance Report Letter Sent SEPTIC TANKS Material: precast concrete Capacity: 1000, 1000,1000 Tank Filter. DRAINFIELD Treatment Area: 70142 Soil Boring: yes OF Ht above We 3 WELL DATA Setback,-Well-Tanks: Well-OF: Report in File?: Depth: INSPECTION RECORD PUMPOUT RECORD faate Description nate Gallons 6/26/95 replacement installation 09/28/01 2000 10/28/97 no surfacing 11/01/02 no surfacing.code system 10/25/04 O coy 11/01/06 4/7/2009 12:40:37 PM