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Home My WebLink AboutCompliance Inspection Form V Minnesota Pollution Control Agency Compliance Inspection Form 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Patti,MN 55155-4194 Doc Type:Compliance and Enforcement Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: 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): 8/12/2017 ® 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 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: Property address: 4645 Bayside Rd Orono MN Reason for inspection: property transfer Property owner: Eric Sims Owner's phone: or Owner's representative: Representative phone: Local regulatory authority: City of Orono Regulatory authority phone: Brief system description: 2-1000gal septic tanks 1000 al pump tank mound treatment with 10ftX63ft rockbed 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: Andrew Kleindl Certification number: 7927 Business name: Jim's Exca atin LLC License number: 2926 Inspector signature: L ' ��ti" Q.(.L ' Phone number: 952-442-9282 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-wY4sts4-31b • 614114 Poge i of 3 Property address: 4645 Bayside Rd Orono,MN Inspector initials/Date: 4-1 oZ 71 IF (mm/dd4Wy) 1. Impact on Public Health—Compliance component#1 of 5 Compliance criteria: Verification method(s): System discharges sewage to the ❑Yes ®No ®Searched for surface outlet round surface. ®Searched for seeping in yard/backup in home System discharges sewage to drain ❑Yes ®No ❑Excessive ponding in sal system/D-boxes file or surface waters. ❑Homeowner testimony(See CommentsiExplanation) System causes sewage backup into ❑Yes ®No ❑"Black soil"above soil dispersal system dwelling or establishment. [ISystem requires"emergency"pumping Any"yes"answer above indicates the ❑Performed dye test system is an imminent threat to public ❑ Unable to verify(See CommenwExpianation) health and safety. ❑Other methods not listed(See CommentslExplanation) Comments/Explanation: 2. Tank integrity—Compliance component#2 of 5 Compliance criteria: Verification method(s): System consists of a seepage pit, ❑Yes ®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. ❑ 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 ❑ Unable to verify(See CommentsExplanation) system is failing to protect groundwater. ❑Other methods not listed(See Comments/Explanation) CommentalExplanation: 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 groundwater for other conditions as determined by inspector. ❑Yes* ®No *System/s falling to protect groundwater. Explain: www.pca.state.mn.us • 651-2%-6300 • 800-657-3864 TTY 651-282-5332 or Soo-657-3864 • Available in altemattve formats wq-wwlsts4-31b • 614114 Page 2of3 Property address: 4645 Bayside Rd Orono MN Inspector initials/Date: (mn✓dd/yyyy) 4. Soil Separation—Compliance component#4 of 5 Date of Installation: ®Unknown Verification method(s): (mm/d& WW) 3horelandWellhead protectionlFood beverage Soil observation does not expire.Previous soil lodging? ❑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 ❑Yes ❑No ®Conducted soil observation(s)(Attach boring logs) not located in Shoreland or Wellhead Protection Area or not serving a food, ❑Two previous verifications(Attach boring logs) beverage or lodging establishment: ❑Not applicable(Holding tank(s),no drainfiela) Drainfield has at least a two-foot vertical ❑Unable to verify(See commentsExpianation) separation distance from periodically saturated soil or bedrock. ❑Other(See ComrnentsrFxplanatron) Non-performance systems built April 1, ®Yes ❑ No Comments/Explanation: 1996, or later or for non-performance systems located in Shore/and 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 ❑No Indicate depths or elevations systems built under pre-2008 Rules,Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 24 inch sand 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soiUbedrock 16 inch Drainfield meets the designed vertical separation distance from periodically C. System separation 40 inch saturated soil or bedrock. D. Required compliance separation* I 36 inch 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 10 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 Operati Permit r uirements been met? ❑Yes ❑No b. Is the required nitrogen BMP in place and_propedy functioning? ❑Yes El 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 local ordinance.If the system is failing to protect ground water,the system must be upgraded,replacer!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 . 651-2%-6300 800-657-3864 TTY 651-282-5332 or 800-657-3864 • Available in altemative formats wq-wwtsts4-31b . 614114 Page 3 of 3 or,-"o, YnAJ t9' S = �` /►tau =gam" - V13 r is E *t -tGOCJ 9a�StirD�ziC �S t�UO g cc fiMZ�toPteaN 6 ik 10,616 o