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Home My WebLink AboutCompliance Inspection Form (SSTS) Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems V (� ql St.Paul,MN 55155-4194 (SSTS) Doc Type:Compliance and Enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency(MPGA) For local tracking purposes: requirements and attached forms—additional local requirements may also apply. NO �/ Submit completed form to Local Unit of Government(LUG)and system owner within 15 days ystem Status System status on date mm/d ( \ �1 ( dlyyyy): 7!30!2012 C( ®Compliant—Certificate of Compliance ❑Noncompliant—Notice of Noncompliance \ l (Valid for years from report date,unless shorter time (See Upgrade Requirements on page 3) v J \ frame outlined in Local Ordinance.) Reason(s)for noncompliance(check all applicable) 0 Impact on Public Health(Compliance Component#1)—Imminent threat to public health and safety po ❑Other Compliance Conditions(Compliance Component#3)—Imminent threat to public health and safety ❑Tank Integrity(Compliance Component#2)—Farling to protect groundwater ❑Other Compliance Conditions(Compliance Component#3)—Faiing to protect groundwater ❑Soil Separation(Compliance Component*4)—Failing to protect groundwater ❑Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant Property Information Parcel l or Sec/Twp/Range: 3311823410004 Property address: 2400 Woodhaven Drive.,Orono.MN Reason for inspection: Property Transfer Property owner. Tor Aasheim Owner's phone: or Owner's representative: Mimi Ryerse Representative phone: 952-475-4913 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. Inspector name: Joseph J Olson Certification number. 1255 Business name: Rusty son's Soil&Parc.Testing License number. 810 Inspectorsignaturee,, —�,� Phone number. 763-498-8779 Necessary or Locally Required Attachments ®Soil boring logs ®System/As-built drawing ❑Forms per local ordinance 0 Other information(list): www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-262-5332 or 800-657-3854 - Available in alternative formats wq-wwists4-31 • 1/24/12 Page l of 3 • Property address: 2400 Woodhaven Drive.,Orono,MN Inspector initials/Date: J.O.7/30/12 1. Impact on Public Health—Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharge sewage to the 0 Yes ®No ® Searched for surface outlet ground surface. ® Searched for seeping in yard/backup in home System discharge sewage to drain the ❑Yes ®No ❑ Excessive ponding in soil system/D boxes or surface waters. 0 Homeowner testimony(See Comments/Explanatan) System cause sewage backup into Yes ®No 0 Black sort above soil dispersal system dwelling or establishment ❑ System requires emergency pumping 0 Performed dye test Any"yes"answer above indicates the system is 0 Unable to verify(See Comments/Explanation) an Imminent Threat to Public Health and Safety. ❑ Other methods not listed(See Comments/Explanaton) Comments/Explanation: 2. Tank Integrity—Compliance component#2 of 5 Compliance criteria: Verification method(s): System consists of a seepage pit, ❑Yes ®No 0 Probed tank(s)bottom cesspool,drywall,or leaching pit. 0 Examined construction records Seepage Pits meeting 70802550 may be ❑ Examined Tank Integrity Form(Attach) compliant I allowed in local ordnance. ❑ Observed liquid level below operating depth Sewage tank(s)leak below their ❑Yes ®No 0 Examined designed operating depth. empty(pumped)tanks(s) If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for`black soil" Any"yes"answer above inthcates the ❑ Unable to verify(See CommerhtdErplanation) system is Failing to Protect Groundwater. 12:1 Other not fisted(See Comments/Explanation) Comments/Explanation: Elmer J Peterson pumped the tanks on 7/27/12 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,ems)to immediately and adversely impact public health or safety. 0 Yes* ®No 0 Unknown 'System is an imminent threat to public health and safety Explain: c. System is nonprotective of ground water for other conditions as determined by inspector 0 Yes- ®No *System is failing to protect groundwater Explain: www.ptastate.mn.ua • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 - Available in alternative formats wq-wwtsts4-31 - 1/24/12 Pose 2of3 Property address: 2400 Woodhaven Drive_,Orono,MN Inspector initials/Date: 10.7/30/12 4. Soil Separation—Compliance component#4 of 5 Date of installation: 11/19/87 0 Unknown Verification method(s): Shoreland/Wellhead protection/Food rage ❑Yes No Soil observation does not expire.Previous soil Lodging observations by two independent parties are sufficient, Cor•fiance criteria: unless site conditions have been altered or local requirements differ. For systems built priorfo April 1,1996,and ®Yes ❑No not located in Shoreland or Wellhead ® Conducted sal observation(s)(Attach boring logs) Protection Area or not serving a food, 0 Two previous verifications(Attach boring logs) beverage or lodging establishment ❑ Not applicable(Holding tank(s),no dra nfield Drainfield has at least a two-foot vertical 0 Unable to verify(See Commen separation distance from periodicallyts/Fxplana0on) saturated soil or bedrock 0 Other(See Comments/Explanation) Non-performance systems bra7tApril 1, 0 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 sod or bedrock.` Experimenter,`Other'or Performance' ❑Yee 0 No Indicate depths of elevations systems built under pre-2008 Rules;Type N or V systems built under 2008 Rules(7080. A_ Bottom of distribution media 100.8 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated sod/bedrodc 98.6 Drainfield meets the designed vertical C. System separation 22 separation distance from periodically saturated soil or bedrock D. Required compliance separation' 2_0 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 0 No If"yes",A below is required Is the system required to employ a Nitrogen BMP? 0 Yes 0 No If'yes",B below is required BMP=Best Management Pracfce(s)specified in the system design /f 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 0 No Any"no"answer indicates Noncompliance. Upgrade Requirements(Alun.Stat§115.55)An imminent threat to public health and safety(17PHS)must be upgraded,replaced,or its use discontinued within ten months of receipt of this notice or wdrrin a shorter period if required by local ordnance.lithe system is failing to protect ground water,the system must be upgraded,replaced,or 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,noowrtlrstandrg any local ordinance that is more strict This provision does not apply to systems in shoreland areas, Wellhead Protection Ames,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 313 Tank Report Date: July 27.2012 Elmer J.Peterson Co. 3921 Dague Ave. Delano,MN 55328 Phone 763-972-2420 Fax 763-972-7217 MPCA License#219 Tor Aasneirn 2400 Woodhaven Drive Long Lake,MN 55356' Baffles: ON / OFF Tank Capacity: 3-1000 Gallon TankS #of Tanks: 3 Type of Tanks: Concrete Gallons Pumped: 2500 Manholes to Grade: elp/ NO Comments: On July 27,2092,Diner J.Petersen Co.pumped septic tanks. No cracks or water leaks at that time. NOTE:E:This is only a rank report This is not a compliance inspection for point of sale nor does it replace a compliance inspection. License#219 Property address: 2400 Woodhaven Drive inspector initis s/Date: 727/12 1. Impact on Public Health—Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharge sewage to the 0 Yes ❑No 0 Searched for surface outlet ground surface 0 Searched for seeping in yard/backup in home System discharge sewage to drain tile 0 Yes 0 No 0 ve ponding in soil system/D bones or surface waters. ❑ Homeownertestimony(See CommentsiExplanaeon) System cause sewage backup into ; 0 Yes 0 No CI "Black soil'above soil dispersal system dwelling or establishment ❑ System requires`emergency pumping ❑ Performed dye test Any"yes"answer above incicates the system is 0 Unable to verify(See Comments/aplanatron) an Imminent Threat to Public Health and Safety- ❑ Other methods not listed(See Commentsr5xplanadon) Convnents/Fxplantion: 2. Tank Integrity—Compliance component#2 of 5 Compliance criteria: Verification method(s): System consists of a seepage pit0 Yes ®No 0 Probed tank(s)bottom cesspool,drywell,or leaching pit ❑ Examined construction records Seepage pits meeffng7080.2550 maybe 0 Examined Tank Integrity Form(Attach) compliant if:Bowed in focal ordinance. _ Sewage tank(s)leak below their ❑Yes ❑ Observed liquid level below operating depth designed operating depth. 0No ® EnMined empty(pumped)tanks(s) if yes,which sewagetank(s)leaks: ❑ Probed outside tank(s)for black soil' Any"yes"answer above indicates the ❑ Unable to verify(See CommerrtvExplanaffon) system is Failing to Protect Groundwater. ❑other methods not listed(See Comments/Fxplanabon) Comments/Explanation: On 727/12, Elmer J.Peterson Co.pumped the septic tanks. No cracks or water leaks at that time. 3. Other Compliance Conditions—Compliance component#3 of 5 • a Maintenance hole covers are damaged,cracked-unsecured or appear to structurally unsound. ❑Yep' No 0 Unknown b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. 0 Yes" 0 No 0 Unknown "System is an imminent threat to public health and safety blain: c. System is non-protective of ground water for other conditions as determined by inspector 0 Yes' ❑No -system is failing to protect groundwater Explain: www-pcastate.nvtus • 651-296-6300 . 800-657-3864 • TTY 651-282-5332 or 800-857-3864 • Available in alba-native fomlars wq-wwists4-31 • 1/24/12 Paget of Logs of Soil Borings License#810 Location or Project 2400 Woodhaven drive. Borings made by: Rusty Olson's Soil and Perc testing 7/30/2012 Classification System: AASHO ; USW,USDSSCS_X_; Unified :Other Auger used(check two):Hand X_,or Power__,Flight,Bucket or Probe X Boring Number_1_Surface elevation_100.2 Mottled Soil at_1.2_feet 0"-14"Dark brown loam 10yr3/2 H2O present at_X_ 14"-20"Rusty dark brown loam to clay loam 10yr3/2 Boring Number_2_Surface elevation_99.0_ Mottled Soil at_1.3_feet 0"-16"Dark brown loam 10yr3/2 H2O present at X 16"-30"Rusty brown clay loam 10yr3/2 30"-36"Rusty olive brown clay loam 2.5y4/3 TBM:Top oflift station manhole cover Elv-100.00 assumed Original grade under the rockbed Dv.-99.8 Bottom of rock bed Elv-100.8 There is 1.0 feet of sand under the rockbed SEPTIC SYSTEM INVENTORY Site Address: 2400 Woodhaven Dr PID: 3311823410004 Owner Name: Tor C.Aasheim Owner Address: 2400 Woodhaven Dr Long Lake MN 55356 Building Type: residence Installer: Date of Permit 11/12/87 Widmer Bros. System Type: mound BRs Designed for: 3 In Musa?: No Shoreland?: SEPTIC COMPLIANCE INSPECTION Compliant Report Date: Expires: Non-Compliant?: • Report in Street File?: SPECIAL NOTES Site Address: 2400 Woodhaven Dr 05/22/08 2008 Septic Maintenance Report Ltr Sent SEPTIC TANKS Material: precast concrete Capacity: 1000,1000,1000 Tank Filter: DRAINFIELD Treatment Area: 62'34 Soil Boring: no OF Ht above Wt 3 WELL DATA Setbacks-Well-Tanks: 75 Well-OF: 75 Report in File?: Depth: 182 INSPECTION RECORD PUMPOUT RECORD Date Description Date Gallons 11/19/87 installation 03/08/92 3000 8/2690 no surfacing-need risers 05/04/94 3000 7/23/91 no surfacing-need risers,pump tanks 1026/07 3000 5/11/93 no surfacing 1 26/94 pump replaced and ext.elect box added 10/4/96 no surfacing 1122/99 no surfacing 10/27/01 code system.no surfacing 11/21/03 no surfadng,pump tanks(3 yr) 09/01/05 Okay 07/01/07 Okay • • 4/72009 233:15 PM ijocc d112n tX • 10> - -� A • 1 • 100 3 - l�fio ZS'( 7y Zo' lb's- 4 7,A,�• ®9 T3 35' )b'/D --- L))POD E./Acti b ,