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HomeMy WebLinkAbout2015 - MPCA compliance inspec. form Apr 17 15 09:40a Joseph Olson 763-498-8290 p.2 Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems St.Pau I,MN 551554+194 (SSTS) Doc Type:Compliance`` and enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency(MPCA) For local trac rlrciblie ED requirements and attached forms—additional local requirements may also apply. Submit completed form to Local Unit of Government(LUG)and system owner APR 1 6 2015 within 15 days CITY OF ORONO System Status System status on date(mmlddlyyyy): 4/1612015 ® Compliant—Certificate of Compliance ❑ Noncompliant—Notice of Noncompliance (Valid for 3years 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: 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 1 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: Joseph J Olson Certification number: 1255 Business name: Rus son's Soil&Pero.Testing - License number: 810 Inspector signature: 1 Phone number 763-498-8779 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-wwlsts4-31 • 1/24/12 Pagel of 3 Apr 17 15 09:40a Joseph Olson 763-498-8290 p.3 Property address: 2785 White Oak Circle, Orono,MN _ Inspector initials/Date: J.0.4/17115 Impact on Public Health—Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharge sewage to the I ❑Yes Z No ® Searched for surface outlet ground surface. ® Searched for seeping in yard/backup in home System discharge sewage to drain tile 0 Yes ® No D Excessive ponding in soil system/D boxes or surface waters. 0 Homeowner testimony(See Comments/Explanation) System cause sewage backup into ❑Yes ® No 0 "Black soil"above soil dispersal system dwelling or establishment. 0 System requires"emergency'pumping 0 Performed dye test Any"yes"answer above indicates the system is ❑ Unable to verify(See Comments/Explanation) an Imminent Threat to Public Health and Safety. 0 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 Z No 0 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. ❑ 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: D Probed outside tank(s)for"black soir 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) Com m entsfExplan ation: 3. Other Compliance Conditions—Compliance component#3 of 5 a. Maintenance hole covers are damaged,cracked,unsecured,or appear to structurally unsound. ❑Yes" ®No ❑Unknown b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. ❑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 ❑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 • 1124117 Page 2of3 Apr 17 15 09:40a Joseph Olson 763-498-8290 p.4 Property address: 2785 White Oak Circle,Orono,MN Inspector initials/Date: J.O.4/17/15 4. Soil Separation-Compliance component#4 of 5 Date of installation: 9/12/96 ❑ Unknown Verification method(s): Sthoreland/Wellhead protectionlFood Beverage ❑Yes Lodging? ® No Soil observation does not expire. Previous soil observations by two independent patties are sufficient, Compliance criteria: unless site conditions have been altered or local For systems built prior to April 1, 1996,and CIYes 0 No requirements differ. not located in Shomland 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 drain5eld) Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) separation distance from periodically saturated soil or bedrock_ ElOther(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.* "Experimenter; "Other,or Performance" ❑Yes ❑No Indicate de sths of elevations systems built under pre-2008 Rules;Type 1V or V systems built under 2008 Rules(7080. I A. Bottom of distribution media 102.5 2350 or 7080.2400 (Advanced Inspector License required) B. Periodical) saturated soil/bedrock 99.5 Drainfield meets the designed vertical C. S stem se•aratian 3.0 separation distance from periodically saturated soil or bedrock. D. 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 $MP*--Compliance component#5 of 5 ® Not applicable Is the system operated under an Operating Permit? ❑Yes El No If"yes",A below is required Is the system required to employ a Nitrogen BMP? 0 Yes ❑ No If"yes",B below is required SMP=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 functioning? ❑Yes ❑ No Any"no"answer indicates Noncompliance. Upgrade Requirements(Minn.Stat§115.55)An imminent threat to public health and safety(1TPHS)must be upgraded,replaced,or its use discontinued within ten months of receipt of this notice or within a shorter period if required by focal ordinance.If the system is failing to protect ground water,the system must be upgraded,replaced,or its use discontinued within the time required try local ordinance. /f 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 • 1124/12 Page 3 of 3 Apr 17 15 09:41a Joseph Olson 763-498-8290 p.5 Apr.17.20.15 08:56 AM Duane's Septic Service 7634972764 PAGE. 1/ 1 Parcel number: . System statue: Compliant El Noncompliant, lag detsnnine , rgg Tank Integrity and Safety Compliance . St i !, M . Compliance Issue#2 of 4 - Date of observation: j±.5.1":______ Reason for observation:. _ • 'Se l{ti L - This form expires on(three years):- j.(L4- ( • . • Compliance questlonslcriteria:(Required) Verification Method",":(Optianal) • JCheck the appropriate box) ' (Check the appropriate box) • Does the System consist of aseepage piM, 0 Yes 2(o 7 prod tank bottom cesspool,drywell,or leaching ph? • Do any sewage tanks)leak below their. 0 Yes Er/NoObserved tow liquid levet ' designed operating depth? ' 0 Examined construction records _ • - If yes,identify which sewage • a Examloed empty(pumped)lank tank leaks. . Any"yes"answer Indicates that the system Is failing to protect ❑ Probed-outside tank for"black still' ground water, . 0 Pressure/vacuum-check _ Seepage pits meeting 7086.2550 may be compliant if allowed Cl Other: • . in ordinance by focal permitting authority. - No ttoo dand protocol exists. This list Is not exhaustive,in• - . asquentlel order, nor does 11 indicate which oarr►binsrlavis are neoassary to-inake.this deterinlnatlon.' Safety Check 1. Are any maintenance dole covers damaged,cracked,or appeared to be structurally unsound? • 0 Yea"` . j1tb-• ` •2. •Werealimainlenance hole covers replaced in a secured manner lag.;all.screwe replaced)? .. lZYes 0.Nos" 3. - Was secondary emcees restraint present(safety pan,second cover,or safety netting)-highly recommended. 0 Yea ego - •• - 4; Was any other safety/health issue present? • - . 0 Yes' 2. d- - Expleln• • • . . .'System Is an Imminent threat to pr7b/Ic health and safety- . • - Certification . This form Is to be completed and attached to the Summary Form of.tfse Minnesota pailution Control Agency's(MPCA)•Compllnnce • Inspection Form for Existing Subsurface Sevv*ge•Treatrnent Systems,.Observations,Interpretations,and conclusions must be.. . vompleted.by an Inspector.maintainer,or service provider,Completed form must be submitted to the local unit of governrnaht within is days, . Property owner neme(s): . . . - Property address: ____ ____72,,S_., �nr Y +L )f g iC C r Property owner's address hrdifferent): . • County: . . Phone: - . •• I hereby certify that I personally made the observations,interpretations,end conclusions naported on this form and that they are • coireCt. Name: ,r 4 e-LCher . . Certification number: C..a C) $'1/ ' Bullhead license name and number. ;.-.)1.1C t7;-i 5p pi-it_ cer yrr,a', L1., - 4,a t/- or • Name of local un vemment: • - Signature: I - - t}ste: -1 y-/ ' wq wwlsts4•3I . , . Compliance Inspection Form for ExIsting SSTS Apr 171509:41a Joseph Olson 763-498-8290 p.6 •27 /J1 Oak_ Ci frI r _____________________,,,T,,, \\\ L x,s7+NL A 1H.,se UJELL 1 Tui' or: MAUK16 > z7S ,7 / I _ 1 s3¢4 sa,,1 t 7► +i-1- 2v7 393 01A- 3- 6(3 qq13 T 04 33 7 J-- iDb Apr 17 15 09:42a Joseph Olson 763-498-8290 p.7 Loas of Soil Borinas License#B1i; Location or Project: 2785 White oak Circle orinas made by: Rusty Olson's Soil and Pero testing 411612015 .;iassification System: AASHO USDS.USDSSCS X ; Unified ; Other Huger used (check two): Hand_X__, or Power , Flight, Bucket or Probe X Boring Number_1_Surface elevation_100.5_ Mottled Soil at_ 1.2 re-F-= 0"-10"Dark brown loam 10yr312 H2O present at_ _ 10"-14"Brown loam 10yr4:: 14"-20" Rusty brown loam to clay loam 10yr4/4 Boring Number_2s Surface elevation_101.0 Mottled Soil at_1.0_feet 0"-12" Dark brown loan 10yr312 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 Ely-100.5 Bottom of rock bed Elv.-102.5 There is 2.0 feet of sand under the rockbed