The URL can be used to link to this page

Home My WebLink About2009 - compliance inspection form (SSTS) 04/18/2009 14: 30 7634988290 RUSTYS PERC TESTING PAGE 02 Minnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155-4194 Instructions on page 7 Parcel number: 33-118-23-41-0007 For Local Tracking Purposes: System status: ® Compliant ❑ Noncompliant (based on all compliance requirements) Summary Form Property Information Property owner name(s): Foreclose Property address: 2550 Woodhaven Drive Property owner's address(if different): County: Hennepin Property owner phone: Permitting authority: City of Orono Date system constructed: 11/12/04 Reason for inspection: Property Transfer System Description Approximately 2-1250 Gallon septic tank, 1-1000 gallon lift station and Approximately 830 square feet Brief system description: of mound rockbed. Local permit number: Number of bedrooms: 6 Design flow rate: .83 Is the system: In Shoreland area? ❑Yes ® No in Wellhead Protection Area? ❑Yes ® No An U.S. Environmental Protection System serving a Minnesota Department Agency(EPA)Class V Injection Well?❑Yes ® No of Heath(MDH)licensed facility? ❑Yes ® No Compliance Status(Based on state requirements—additional local requirements may also apply.) Based on the Information gathered and reported on attached forms,the compliance status of this system is(check one): ® Certificate of Compliance—valid until(3 years from date of report); 4/9/2012 ❑ Notice of Noncompliance-For Noncompliant systems: The reason for noncompliance is; This noncompliant system Is classified as(check one below): ❑ Imminent threat to public health&safety ❑ Falling to protect ground water 0 Not in compliance with operating permit Certification (Completed form must be submitted to the local unit of government within 15 days.) 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. Name: Joseph J.Olson _ Certification number: 1255 Business license name and number: Rusty Olson's soil and perculation testing Lic#810 or Name of local unit government: City,of Orono Signature: Date: 4/09/09 _. Require Attachments Inspector Complete: This Inspection Report is ; pages long. Check compliance forms attached: ®Hydraulic Performance ❑Tank Integrity ®Soli Separation ❑Operating Permit Form(if applicable) 0 System drawing/As-built drawing El An assessment of any local requirements that are different from what is required on this form ®Soll Boring Logs ❑Abandonment form(If appropriate) 0 Other Information(list): Upgrade Requirements (derived from Minn. Stat.§115.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced,or its use Olsconhnued within len months of receipt of this notice or within a shorter period If required by local ordinance.If the system Is felling to protect ground water,the system must be upgraded repined 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 lire system need not be upgraded.repaired,noticed,or its use discontinued,notwithstanding any local o'Oinance that Is more strict. This provision does not appy to systems In shore/end areas,Wellhead Protection Areas,or those used in connection with too', beverage,and lodging establishments as defined in law. wq-wwtsts4 31 Comnitnncp lncn,arttnn Fnrrn fnr cvt«tnn ccrc 04/18/2009 14:30 7634988290 RUSTYS PERC TESTING PAGE 03 Parcel number: 33-118-23-41-0007 System status: ® Compliant ❑ Noncompliant (as determined by this form) Hydraulic Performance and Other Compliance Compliance issue #1 of 4 Date of observation: 4/09/09 Reason for observation; Property Transfer This form expires upon next inspection or in three years,whichever occurs first: 4/09/12 Compliance questions/criteria: (Required) Verification Method": (Optional) (Check the appropriate bOX) (Check the appropriate box) Does the system discharge sewage to the ❑Yes ® No ® Searched for surface outlet round surface? Does the system discharge sewage to drain ❑Yes ® No ❑ Performed hydraulic test tile or surface waters? [4 Searched for seeping in yard Does the system cause sewage backup 0 Yes E No ® Checked for backup in home into dwelling or establishment? 0 Excessive ponding in soil system/D-boxes Do other situations exist that have the 0 Yes ® No potential to immediately and adversely Homeowner testimony impact or threaten public health or safety ❑ Examined for surging in tank (electrical,unsafe covers.etc. ? ❑ "Black soil"above soil dispersal system Any"yes"answer Indicates that the system Is an imminent threat to public health end safety. ❑ System requires'emergency pumping ❑ Performed dye test Does the system pose a threat to ground 0 Yes ® No water for any conditions deemed non- ❑ Other: _ protective as determined by the inspector? "Yes"Indicates that the system Is foiling to protect ". .. ground water.If"yes", describe the condition noted: 'No standard protocol exists. This list is not exhaustive, in sequential order, nor does It indicate which combinations are necessary to make this determination. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems.Observations, interpretations, and condusions must be completed by an inspector, Completed form must be submitted to the local unit of government within 15 days. Property owner name(s): Foreclose Property address: 2550 Woodhaven Drive Property owner's address(if different): County: Henna in Phone: I hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they are correct. Name: Jos ph J.Olson Certification number; 1255 Business license name and number: Rus Olson's soil and rculation testin Lic#810 or Name of local u of government: City of Orono _ Signature Date: 4/09/09 • wq-wwisrs4-31 Cemnlinnry InenorHnn Fnrm f,,. cc-rc 04/18/2009 14:30 7634988290 RUSTYS PERC TESTING PAGE 04 Parcel number: 33-118-23-41-0007 System status: ® Compliant ❑ Noncompliant (as determined by this form) Tank Integrity and Safety Compliance Compliance Issue #2 of 4 Date of observation: 4/09/09 Reason for observation: Property Transfer This form expires on(three years): 4/09/12 Compliance questions/criteria: (Required) Verification Method": (Optional) (Check the appropriate box) (Check the appropriate box) Does the system consist of a seepage pit', ❑Yes ❑ No ❑ Probed tank bottom cesspool,drywell,or leaching pit? Do any sewage tank(s) leak below their 0 Yes ❑No ❑ Observed low liquid level designed operating depth? ® Examined construction records If yes,identify which sewage 0 Examined empty(pumped)tank tank leaks. _ Any"yes"answer Indicates that the system Is failing to protect CI Probed outside tank for"black soil" ground water. ❑ Pressure/vacuum check Seepage pits meeting 7080.2550 may be compliant if allowed ❑ Other: in ordinance by local permitting authority. No standard protocol exists, This list is not exhaustive,in sequential order, nor does N indicate which combinations are necessary to make this determination. Safety Check 1. Are any maintenance hole covers damaged,cracked, or appeared to be structurally unsound? ❑Yes' ® No 2. Were all maintenance hole covers replaced in a secured manner(e.g.,all screws replaced)? ®Yes 0 No' 3. Was secondary access restraint present(safety pan,second cover,or safety netting)—highly recommended. 0 Yes 0 No 4. Was any other safety/health issue present? 0 Yes' No Explain: 'System is an imminent threat to public health and safety. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations,interpretations,and conclusions must be completed by an inspector, maintainer,or service provider. Completed form must be submitted to the local unit of government within 15 days. Property owner name(s): Foreclose Property address: 2550 Woodhaven Drive _ w Property owners address(if different): County: Hennepin Phone: I hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they we correct Name: Joseph J.Olson Certification number: 1255 Business license name and number: Rusty Olson's soil and rculation testin Lic#810 or Name of local unit of government: City n Orono Signature; Date: 4/09/09 wq-ww sts4-31 CornDlinnry/ncnortrnn Fnrm Few C..:,+J....ccx 04/18/2009 14: 30 7634988290 RUSTYS PERC TESTING PAGE 05 Parcel number: 33-118-23-41-0007 System status: ® Compliant ❑ Noncompliant (as determined by this form) Soil Separation Compliance and Other Compliance Compliance Issue #3 of 4 Date of observation: 9/3/08 Reason for observation: Property Transfer This information on this form does not expire. Compliance questlonslcriterla: (Required) Verification Method": (Optional) Check the a.• trate box (Check the appropriate box) For systems built prior to April 1, 1996,and not located in Shoreland or Wellhead Protection ® Conducted soil observation(s) (attach boring logs) Area or not serving a food, beverage or ❑ Two previous verifications(attach boring logs) lodging establishment: 0 Other: Does the system have at least a two-foot vertical separation distance from periodically saturated soil or bedrock? ■ Yes p No For non-performance systems built April 1, 1996,or later or for non-performance systems located in Shoreland or Wellhead Protection Soil observation does not expire. Previous observations Areas or serving a food, beverage or lodging by two independent parties are sufficient, unless site establishment: conditions have been altered. Does the system have a three-foot vertical separation distance from periodically saturated soil or bedrock?' ®Yes ■ No For reduced separation distance systems(i.e., 'performance"systems under old 7080.0179 or ' May be reduced by up to 15 percent If allowed in local Type IV or V system under new 7080.2350 or ordinance. 7080.2400): `•No standard protocol exists. This list Is not exhaustive, Does the system meet the designed vertical in sequential order, nor does it indicate which separation distance from periodically saturated combinations am necessary to make this soil or bedrock?* 0 Yes ►ii No determination. Any"no"answer indicates that the system Is falling to protect ground water. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations,and conclusions 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): Foreclose Property address: 2550 Woodhaven Drive Property owners address(if different): County: Hennepin - Phone: I hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they are correct. Name: Joseph J.Olson Certification number: 1255 Business license name and number: Rusty Olson's soil and perculation testing LIc$810 or Name of local unit ovemment: Ci of Orono Signature: Date: 4/09/09 • wq-wwists4.31 r'mmnlrnnro Incrwrrfnn c,...n /nom r..,..i,... crrr 04/18/2009 14: 30 7634988290 RUSTYS PERC TESTING PAGE 06 55Q Wood hatwe n .4 MMS 3o 341* Kt' 4 ' 364 fr 3 co: 94'6 I' 4 Hook 41 •• C7 A. P 04/18/2009 14: 30 7634988290 RUSTYS PERC TESTING PAGE 07 jogs of Soil Borings License#810 Location or Project; 2550 Woodhaven Drive Borings made by: Rusty Olson's Soil and Parc testing 1/23/2009 Classification System: AASHO ; USDS-USDS-SCS X ; Unified ; Other Auger used(check two); Hand Xor Power . Flight.Bucket or Probe X_ Boring Number_1 Surface elevation_93.0_ Mottled Soil at 1.5 feet 0"-18"Dark brownl 10yr3/2 M20 present at X 18"-24" Rusty brown loam 10yr4/4 24"-30" Rusty olive brown loam 2.5y5/3 Boring Number_2 Surface elevation_94.9_ Mottled Soil at_1.7 feet 0-20" Dark brown loam 10yr3/2 H2O present at X 20"-24" Rusty brown loam 10yr4/4 24"-30" Rusty brown clay loam 10yr5/4