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Home My WebLink AboutCompliance Inspection Form //ac2 �K�c�debkle Minnesota Pollution Compliance Inspection Form Control Agency Existing Subsurface Sewage Treatment Systems (SSTS) �1 La'ayetti�Road Notth S; Pain,MN 4194 Doc Tyoe:Compliance and E,)forc;cmenr Inspection results based on Minnesota Pollution Control Agency(MPGA) 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(mmlddlyyyy): 11/15/2017 71 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 permitlmonitoring plan requirements(Compliance Component#5)-Noncompliant Property Information Parcel ID#or Sec/Twp/Range 0311723430002 Property address. 1925 Fox Street.Wayzata, MN Reason for inspection: c. Property owner: Jen Ostergaard Owner's phone: 763-350-7250 or Owner's representative: SAME Representative phone: Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4626 (2) 1000 gallon septic tanks,(1) 1000 gallon pump tank. Above grade drainfield, a 10x50 Rock Bed Brief system description: with 12 inces of sand under the rockbed. Comments or recommendations: Tanks were pumped and certified by others. Sewage Tank Compliance Certification is attached to this document. Maintain system by pumping the tanks every 3 years. 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 constructior. possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Pernel"Chip" Hentges Certification number: Business name: `'Chips Septic Se_ es LLC License number: 2064 Inspector signature: Phone number: 952-200-3176 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 Availab e in after^ati,, wq-wwists4-31 • 3/16112 Fa4e t c 3 Property address: 1925 Fox Street,Wayzata, MN Inspector initials/Date 11;151201 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 ground surface. ® Searched for seeping in yard/backup in home System discharges sewage to drain ❑ Yes ® No ❑ Excessive ponding in soil system/D-boxes tile or surface waters. ❑ Homeowner testimony(See Comrnents�Ext7lena�+ons System causes sewage backup into ❑ Yes ® No ❑ "Black soil'above soil dispersal system dwelling or establishment. ❑ System requires'emergency" pumping Any"yes"answer above indicates the ❑ Performed dye test system is an imminent threat to public ❑ unable to verify(See Comments/Explanation' health and safety. ❑ Other methods not listed (See Cornments/Exolanahon; 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 (Attacf)) compliant if allowed in local ordinance. El Observed liquid level below operating de,�tth Sewage tank(s) leak below their ❑ Yes ❑ No designed operating depth. F1 Examined empty(pumped)tanks(s) If yes.. which sewage tank(s)leaks: EI Probed outside tank(s)for"black soil" Any "yes"answer above indicates the ❑ unable to verify(see Comments/Explanat+on' system is failing to protect groundwater. ® other methods not listed (See CommentsExpl ario'., Comments/Explanation: See attached Sewage Tank Complinace Certification completed by others. 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 O o,,, b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. ❑Yes* ® Nf ❑ *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.stat.e.mn-,:s 651-296-6300 800-657-3864 TTY 651-282 5332 or 800-657-3864 Available in al.tc r:,i,. 0 wq-wwists4.31 • 3;'!6112 Property address: 1925 Fox Street,Wayzata, MN Inspector initials/Date:l-T 11 4. Soit Separation — Compliance component#4 of 5 Date of installation: 8/26/2012 ❑ Unknown Verification method(s): (mmldd/yyyy) Soil observation does not expire. Previous soil Shoreland/Wellhead protection/Food beverage ® Yes ❑ No observations by two independent parties are sut!;c crn lodging? unless site conditions have been altered or loci! Compliance criteria: requirements differ. For systems built prior to April 1. 9996. and ❑ Yes ❑ No ❑ Conducted soil observation(s)(Attach boring logs; not located in Shoreland or Wellhead Two previous verifications(Attach boring Protection Area or not serving a food, logs, beverage or lodging establishment. ❑ Not applicable (Holding tank(s), no dra+nfietd) Drainfield has at least a two-foot vertical ❑ Unable to verify(See CommentslEx)rlanatian) separation distance from periodically ❑ Other(See CommentsiExpianation) saturated soil or bedrock. Non-performance systems built April 1. ®Yes ❑ No Comments/Explanation: 1996, or later or for non-performance systems located in Shoreland or Wellhead See attached soil borings from orginal design. 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 12 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soilibedreck 26 inches Drainfield meets the designed vertical C. System separation >36 inchee separation distance from periodically saturated soil or bedrock. D. Required compliance separation' 31 inches Any "no"answer above indicates the system is 'May be reduced up to 15 percent if allowed by Lecai 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 /f the answer to both questions is "no", this section does not need to be completed. Compliance criteria a. Operating Permit number: ❑ Yes ❑ No Have the Operating Permit requirements been met? b. Is the required nitrogen BMP in place and properly functioning? ❑Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements;?vtinn Stat § 115.55)An imminent threat to public health and safety(iTPHS)must oe upgrades, re, aced, r ;c. discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance If the system is rai +.p to ground water, the system most be upgraded, replaced, or its use discontinued within the time required by local ordinance. If a; r, �tiny s�irrr is not failing as defined in iaw, and has at least two feet of design soil separation, then the system need not be upgraded, repai,ed reprr,r ear' o. its use discontinued notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreiand are<<s, Wellhead Protection Areas. or those used in connection with food,beverage, and lodging establishments as defined in law www.pca-state..rr,n.us 651 296-6300 800-657-3864 TTY 651 282-5332 or 800-657-3864 Avaitabie in alternativ< wq-wwists4 31 • 3/16l i2 r,-e ro a 4n -0 C FA �3 j3L CL to CL c 0 C fr v I? VI) C 7c • CO CL E rt 17 z 311 looi buiddiuS woAj ju@S :1:)afqnS sa6jua[d diq:) :oj M 61V:8 LTU 'TZ jaqW@AC)N Aepsani :juas SablUOH dtq- s 831uaH Cl! LID LJ � � y✓is-�ec��a, WFffcdO1KX1 TCS15 5cgk' kink Hale-WS s7s9an is G b arstn sled to mai I th<gentsda WHv.on Caud Ayer y I i \�.-' ( ,e}:< < +r•. � I Chapter 7080 F Local Ordinan Check all underground titiliti I UNIVERSITY OSTP Soil Observation Log OF MINNESOTA v11.05.31 Client/Address: Joann Watson, 1925 Fox Street Legal Description/GPS: Soil parent material(s): (Check all that apply) ❑Outwash (;Lacus trine ❑Loess Tia E,Alluvium ❑Bedrock ❑Organic Makter Landscape Position: (check one) ❑Summit [,7/j Shoulder ❑Back/Side Slope Foot Slope ❑Toe Slope Slope shape Vegetation grass Soil survey map units HcB2 Slope% 9.0 Elevation: 90.3 Weather Conditions/Time of Day: CLAR1:30PM Date 06/18/12 Observation#/Location: #1 Fraars% Shapel Depth(in) Texture g Matrix Colors) Mottle ColorKind (s)Redox Kins) Indicatorl -Structure---- ture--s) p — Consistence 0-14 loam 10YR 3/3 Granular Weak Friable 14-18 clay loam 10YR 5/3 Prismatic Moderate Firm 18-34 clay loam 10YR 5/6 Prismatic Moderate Firm 34-46 clay loam 10YR 5!6 10YR 6/8 Concentrations S1 Prismatic Moderate Firm i i Concent ati 46-50 loam 10YR 5l6 10YR 7/1; 10YR 6/8 depletions 51 Prismatic Moderate Firrn Commerts I he*eby ce'tify t a.'"avc cc nln!ete:this t..rK i-ac �rJance V'ith SII riot cahle o d .rrccs ales ano _aw l csr,nati,r i v F nr : (Date} Additional Soil Observation Logs Client/ Address:F— 1025 Fox St., Orono Legal Description/ GPS: Soil parent material(s): (Check all that apply) [-I Outwash [' Lacus trine ( Loess [7vj Till F1 Alluvium Bedrock ( Organic Matter Landscape Position: (check one) Summit Shoulder (-j back/Side Slope j-1 Foot Slope [–j 1 oe Slope Slope shape Vegetation grass Soil survey map units HcB2 — Slope% 9.0 Elevation: 89.3 Weather Conditions/Time of Day: 1:30pm clear Date _ 06/18/12 Observation#/Location: #2 Coarse 1-------- Structure-----------I Depth (in) Texture Frag. % Matrix Color(s) Mottle Color(s) Redox Kind(s) Indicator(s) Shape Grade Consistence 0 - 12 loam 10YR 3/3 Granular Weak Friable 12 - 16 clay loam j 10YR 5/3 Prismatic Moderate Firm 16- 26 clay loam s 10YR 516 Prismatic Moderate Firm - -- _ ----- - --- --- Concentratons� --- - - _ - - - 26 - 34 loam 10YR 6/3 10YR 7/1, 10YR 6/8 S1 Prismatic Moderate Firm _ depletions --- -- - - _- - Concentrations, 34 - 42 loam 10YR 6/2 10YR 7/1, 10YR 6/8 S1 Prismatic Moderate Firm depletions t I Comments Observation#/Location: #3 elev. 92.3 Coarse -----------I Depth (in) Texture Matrix Color(s) Mottle Color(s) Redox Kind(s) Indicator(s) Frag. % Shape Grade Consistence 0 - 12 loam 10YR 3/3 u Granular Weak i Friable 12 - 16 loam 10YR 5/3 Granular 1 Weak Friable 16 - 26 clay loam 10YR 5/3 Prismatic Moderate Firm Concentrations; 26 - 30 clay loam 10YR 5/3 10YR 7/1, 10YR 6/8 S1 Prismatic Moderate Firm depletions roncFntrat! ns, 30 - 36 oam tlYZ 5:14 10YF 1 P o . yiah'S1 flrsVtJc es dc-Motions �nl i1r."t5 -Lt 17 1� o ............ 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