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Home My WebLink About2015 - MPCA compliance inspection form Apr 20 15 06:17p Joseph Olson 763-498-8290 p.9 Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems St.Paul,MN 55155-4194 (SSTS) Doc T}rpe omplience and Enforcement KK cCIVED Instructions: inspection results based on Minnesota Pollution Control Agency(MPGA) For local frac in purposes: requirements and attached forms-additional local requirements may also apply. APR 212015 Submit completed form to Local Unit of Government(LUG)and system owner c" within 15 days OF ORONO System Status System status on date(mmldd/yyyy): 4/16/2015 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 safely ❑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/Two/Range: 0411723420014 Property address: 2785 White Oak Circle, Orono,MN Reason for inspection: Property Transfer Property owner: John Dougan Owner's phone: 952-473-0355 or Owner's representative: Representative phone: Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 2-1000 gallon septic tanks,1-1000 gallon lift station and 380 square feet of mound rockbed. per city Brief system description: records 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. Inspectorname: Joseph J Olson Certification number: 1255 Business name: Rus on's Soil&Perc.Testing License number: 810 Inspectorsignatur - --�" Phone number: 763-498-8779 Necessary or Locally Required Attachments ® Soil boring logs 0 System/As-built drawing ❑Forms per local ordinance ❑Other information (list): www.pca.state.mn.us • 651-246-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 + 1124/12 Page 1 of 3 Apr 20 15 06:17p Joseph Olson 763-498-8290 p.10 Logs of Soil Borings License#87{: Location or Project: 2785 White oak Circle 3crings made by: Rusty Olson's Soil and Perc testing 4/1612015 :1.7;assification 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_100.5 Mottled Soil at 1.2 feet 0"-10" Dark brown loam 10yr3/2 H2O present atX 10"-14" Brown loam 10yr4;13 14"-20" Rusty brown loam to clay loam 10yr414 Boring Number_2Surface elevation_101.0_ Mottled Soil at_1.0_feet 0"-12" Dark brown loam 10yr3/2 H2O present at_X_ 12"-18" Rusty brown loam 10yr4/3 TBM:Top of lift station manhole cover Elv.-100.0 assumed Original soil under the rockbed Elv.-100.5 Bottom of rock bed Elv.-102.5 There is 2.0 feet of sand under the rockbed Apr 20 15 06:17p Joseph Olson 763-498-8290 p.11 -2-73. S.- GJ101 Oak- C,r 14..544 ) r — M P 16- ir WELL 1 1 10777 -1Q� / 1uP or OA Odkit'a Y 1 sR•4 sa9), • I A iS Trii4- aril 3q3 00-1-- '3 L/g9 -a mg 33 L/713 O L1f D S6 1 Apr 20 1506:17p Joseph Olson 763-498-8290 p.12 Apr. 17 .2'015 08:56 AM Duane's Septic Service 7634972764 PAGE. 1/ 1 , Parcel number: . System status: Comp1Ient 0 Noncompliant, ' (es detemrine h! 1 05i7,7170P Tank Integrity end Safety Compliance . ,4-.`,'Michltal, M[i11 . Compliance Issue#2 of 4 ' - . - • , Date of observation: Li- (Li-15- Reason for observation: , . =See 1113 ,1 _ . d! This form expires on(three years): -(L- I • J • Compliance questlonislcriteria: (Required) - Verification Method `:(Optional) _ JGheck the appropriate box) • (Check the appropriate bilk) Does the syetern consiatof a•seepage pit`, 0 Yes i ao [alrobed tank botton'i cesspool,drywall,or leaching pit? • • Do any sewage tank(a)leak below their -0 Yes LiNo 0 4bsenled low liquid level designed operating depth? 0/•Examined construction records . - If yes,Identify which sewage ill Examined empty. (Pumped)tank • tank leeks. • Any"yes"answer Indicates that the system fa felling to protect ❑ Proud outside tank br'black loll' ground water, ❑ Pressure/vacuum-check _ ' Seepage pits meeting 70862550 rngy be compliant If allowed ❑ Other: in ordinance by.lacal permitting authority. • • No standard protocol exists. This list/s,not exhaustivo,kr sequential order, nor does It Indicate which combinations ' ' arra nee y to inaka.thla determinstlon; • "Safety Check - 1. Are any maintenance hole covers damaged,cracked, or appeared to be structurally unsound? ❑❑Ver. 2No•• ` •2. Were all maintenance hole covers replaced In a secured manner(e:g.;afl-saews replaced)? idYes 0 No•.' 3. " Was secondary access restraint present(safety pen,second cover,or safely netting)-highly recommended. ❑Yes tom,Ivo 4. Was any other eafelylhealth isaue present? • _ ❑Yes" .12". 6- • Explain: • . 'System Is en Imminent threat to pOb/M health and safety. . . A • • Certification . This form is to be completed and attached to the Summary Form of.the Mlnneevta Pollution Control Agency's(MPC/).Compliance • Inspection Form for Existing Subsurface Sewage•Trealnient Systems..Observatlons,Interpretations,and conclusions must be. . completed.by an inspector,maintainer,or service provider.Completed forth most be submitted to the local unit of government within 15 days. . Property owner name(s): ., Property address: .62 7S o 'ci a,tz... CI(1. • . . Property owners address(!f different): ' • . • County: Phone: : . . • 1 hereby certify that(personally made the observations, Interpretations, end conclusions reported an this form.end that they are COtrect. • Name: ___%.7-/4 Eich,--c .- • Certification number a C),? /- (l Businesa license name end number: Li if2e. �•P ski �i9 r Vor ilma LI. 1.- .- . ' Name of local un ovemment: • . . • Signature; iDale: LI-/'-(-/.,,5• ' wq-wwfsts4'31 . • Compliance Inspection Form for Ekfsting SSTS • A ti 1110 Apr 20 15 06:17p Joseph Olson 763-498-8290 p.13 Property address: 2785 White Oak Circle, Orono,MN Inspector initials/Date: J.O.4117115 4. Soil Separation—Compliance component#4 of 5 Date of installation: 9/12/96 ❑ Unknown Verification method(s): Shoreland/Wellhead protection/Food Beverage ❑Yes ® No Soil observation does not expire. Previous soil Lodging? observations by two independent parties are sufficient, Compliance criteria: unless site conditions have been altered or local 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 riot serving a food, ❑ Two previous verifications(Attach boring logs) beverage or lodging establishment: ❑ Not applicable(Holding tank(s),no drainfield) Drainfieid has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) separation distance from periodically saturated soil or bedrock. ❑ Other(See Comments/Explanation) Non-performance systems built April 1, ® Yes ❑ No Comments/Explanation: 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.` Experimental" `Other; or "Performance" ❑Yes 0 No Indicate depths of elevations systems built under pre-2008 Rules;Type IV --- or V systems built under 2008 Rules(7080. A. Bottom of distribution media 102.5 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated sot/bedrock 99.5 Drainfield meets the designed vertical C. System separation 3.0 separation distance from periodically saturated soil or bedrock. C. Required compliance separation" 2.6 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 ff 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 functioning? ❑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.iI an existing system is not failing as defined in law,and has at least two feet of design soif 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 • 1/24112 Page 3 of 3 Apr 20 15 06:18p Joseph Olson 763-498-8290 p.14 Property address: 2785 White Oak Circle,Orono, MN Inspector initials/Date: J.0.4/17115 7. Impact on Public Health-Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharge sewage to the ❑Yes ® No ® Searched for surface outlet ground surface. ® Searched for seeping in yard/backup in home System discharge sewage to drain tile D Yes ®No ❑ Excessive ponding in soil system/D-boxes or surface waters. ❑ Homeowner testimony(See Comments/Explanation) System cause sewage backupinto 0 "Black soil"above soil dispersal system Y g ❑Yes ®No ❑ System requires"emergency"pumping dwelling or establishment. ❑ Performed dye test Any"yes"answer above indicates the system is ❑ Unable to verily(See Comments/Explanation) an imminent Threat to Public 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, 0 Yes El 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. D Observed liquid level below operating depth Sewage tank(s)leak below their ❑ Yes ® No designed operating depth. ® 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 ElUnable to verify(See Comments/Explanation) system is Failing to Protect Groundwater. 0 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 structurally unsound. ❑Yes* ®No 0 Unknown b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. El Yes` ®No 0 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 p Yes' ®No *System is failing to protect groundwater Explain: www.pca.state.mn.us • 651-296-6300 • BOO-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-3 r • 1/24112 Page 2 of 3