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HomeMy WebLinkAbout02/22/2021 Compliance Inspection FormMINNESOTA POLLUTION CONTROL AGENCY Compliance N liance inspection report form �- 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) St. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency (MPGA) requirements and attached supporting documentation - additional local requirements may also apply. Further information can be found here: htt sa/www. ca.state.mn.us/sites/defaulVfiiles/w-wwists4-31a. df, Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final determination of compliance or noncompliance. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: '0411723310011 Local regulatory authority: City of Orono Property address: 2880 Fox Street, Orono Hennepin Count Owner/representative: Brian Helms Owner's phone: 612-913-6400 Brief system description: 2-1000 gallon septic tanks, 1-1000 gallon lift station and 380 Square feet Rock bed System status System status on date (mmldd/yyyy): 2/22/2021 Z Compliant - Certificate of compliance* ❑ Noncompliant- Notice of noncompliance (Valid for 3 years from report date unless evidence of An imminent threat to public health and safety (ITPHS) must be an imminent threat to public health or safety requiring upgraded, replaced, or its use discontinued within ten months of removal and abatement under section 145A.04, receipt of this notice or within a shorter period if required by subdivision 8 is discovered or a shorter time frame exists local ordinance or under section 145A.04 subdivision 8. in Local Ordinance.) *Note: Compliance indicates conformance with Minn. Systems failing to protect ground water must be upgraded, R. 7080.9500 as of system status date above and replaced, or use discontinued within the time required by local ordinance. does not guarantee future performance. Reason(s) for noncompliance (check all applicable) ❑ Impact on public health (Compliance component #1) - Imminent threat to public health and safety ❑ Tank integrity (Compliance component #2) - Failing to protect groundwater ❑ Other Compliance Conditions (Compliance component #3) - Imminent threat to public health and safety El Other Compliance Conditions (Compliance component #3) - Failing to protect groundwater ❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) - Failing to protect groundwater Soil separation (Compliance component #5) - Failing to protect groundwater ❑ Operating permit/monitoring plan requirements (Compliance component #4) - Noncompliant - local ordinance applies Comments or recommendations The system is sized for a 3 -bedroom house. 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. By typing my name below, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this form. Business name: Rusty Olson's Soil & Perc. Testing Certification number: Inspector signatures- - - — License number: 'V l (This document has been electronically signed) Phone: C-1255 810 763-498-8779 Necessary or locally required supporting documentation (must be attached) ® Soil observation logs ❑ Other information (list): https://www.pca.state.mn,us wq-wwists4-31b • 1/11/21 ❑ Locally required forms • 651-296-6300 800-657-3864 - ® Tank Integrity Assessment ❑ Operating Permit Use your preferred relay service Available in alternative formats Page 1 of 4 1. Impact on public health — Compliance component #1 of 5 Compliance criteria: System discharges sewage to the ❑ Yes' ® No ground surface System discharges sewage to drain ❑ Yes' E No tile or surface waters. System causes sewage backup into ❑ Yes' ❑ No dwelling or establishment. Any "yes" answer above indicates the system is an imminent threat to public health and safety, Describe verification methods and results: Searched area Attached supporting documentation: ❑ Other: ED Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, cesspool, drywell, leaching pit, or other pit? Sewage tank(s) leak below their designed operating depth? Yes" ® No ❑ Yes' ® No If yes, which sewage tank(s) leaks: Any "yes" answer above indicates the system is failing to protect groundwater, Attached supporting documentation: ❑ Pumped at time of inspection Name of maintenance business: License number of maintenance business: Date of maintenance: ❑ Existing tank integrity assessment (Attach) Date of maintenance (mmidd/yyyy): (must be within three years) (See form instructions to ensure assessment complies with Minn. R. 7082.0700 subp. 4 8 (?)) ❑ Tank is Noncompliant (pumping not necessary - explain below) ❑ Other: Describe verification methods and results: The tanks were pmped and certified by Elmer J. Peterson Company. See attached report. https://www.pca.state.mn,us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwfsts4-31b • 1111/21 Poge 2 of 4 3. Other compliance conditions — Compliance component #3 of 5 3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? ❑ Yes' ® No ❑ Unknown 3b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? ❑ Yes* 0 No ❑ Unknown "Yes to 3a or 3b - System is an imminent threat to public health and safety. 3c. System is non -protective of ground water for other conditions as determined by inspector? ❑ Yes" ONO 3d. System not abandoned in accordance with Minn. R. 7080.2500? ❑ Yes* 0 No *Yes to 3c or 3d - System is failing to protect groundwater. Describe verification methods and results: Visual Attached supporting documentation: ® Not applicable ❑ 4. Operating permit and nitrogen BMP* —Compliance component #4 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 specified in the system design? ❑ 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. 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. Describe verification methods and results: Attached supporting documentation: ❑ Operating permit (Attach) ❑ https;//www.pca.state.mn,us wq-wwists4-31b • 1/11/11 651-296-6300 • 800-657-3864 Use your preferred relay service • Available in alternative formats Page 3 of 4 S. Soil separation — Compliance component #5 of 5 Date of installation 05/01/2010 ❑ Unknown (mm/dd/yyyy) Shoreland/'Wellhead protection/Food ❑ Yes ® No beverage lodging? Compliance criteria (select one): 5a. For systems built prior to April 1, 1996, ❑ Yes ❑ No* and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two -foot vertical separation distance from periodically saturated soil or bedrock. 5b. Non-performance systems built April 1, 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.* Attached supporting documentation: ® Soil observation logs completed for the report (Attach) ❑ Two previous verifications of required vertical separation (Attach) ❑ Not applicable (No soil treatment area) ® Yes [:]No* Indicate depths or elevations A. Bottom of distribution media 99.7 5c. "Experimental" "Other", or "Performance" ❑ Yes ❑ No* systems built under pre -2008 Rules; Type IV or V systems built under 2008 Rules 7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. *Any "no" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: B. Periodical C. System separation � 2.9 D. Required compliance separation* 2.55 *May be reduced up to 15 percent if allowed by Local Ordinance. Upgrade requirements: (Minn. Stat. § 115.55) An imminent threat to public health and safety (ITPHS) 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, replaced, 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. https://www.pca.state.mn.us wq-wwists4-31b • 1/11/21 • 651-296-6300 800-657-3854 Use your preferred relay service Available in alternative formats Page 4 of 4 Tank Report Date. February 18, 2021 Elmer I Peterson Co. 5921 Dague Ave. Delano, MN 55528 Phone 765-972-2420 Fax 763-972-7217 MPCA License# 219 Nancy Thompson 2880 Fox Street ,Orono, MN 612-913-6400 Brian Helms (Realtor) Baffles: ON OFF Tank Capacity: 3-1000 Gallon Tanks # of Tanks: 3 Type of Tanks: Concrete Gallons Pumped: 2500 Manholes to Grade: t YES / NO Comments: On February 18, 2021, Elmer J. Peterson Co. pumped tanks. No cracks or water leaking in tanks at the time of pumping. NOTE: This is only a tank report. This is not a compliance inspection for point of sale nor does it replace a compliance inspection. MINNESOTA POLLUTION Sewage tank integrityassessment form CONTROL AGENCY 520 Lafayette Road North Subsurface Sewage St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program Purpose: This form may be used to certify the compliance status of the sewage tank components of the SSTS. This form is not a complete SSTS inspection report, only a tank integrity assessment, and may only certify sewage tank compliance status when entirely completed and signed by a qualified professional. SSTS compliance inspection report forms can be found at: hD§,//www.pca..state,mn.us/waterlinspections. Instructions: This form may be completed, and signed, by a Designated Certified Individual (DCI) of a licensed SSTS inspection, maintenance, installation, or service provider business who personally conducts the necessary procedures to assess the compliance status of each sewage tank in the system. A copy of this information should be submitted to the system owner and be maintained by the licensed SSTS business for a period of five (5) years from the assessment date. When this form is signed by a qualified certified professional, it becomes necessary supporting documentation to an Existing System Compliance Inspection Report: Compliance inspection form - Existing system (wo-wwists4-31 b). This form can be found on the MPGA website at hLtps://www.pca.state.mn.us/water/inspections. The information and certified statement on this form is required when existing septic tank compliance status is determined by an individual other than the SSTS Inspector that submits an inspection report. This form represents a third party assessment of SSTS component compliance and is allowable under Minn. R. 7082.0700, subp. 4 Item (B) subitem (1). This form is valid for a period of three years beyond the signature date on this form unless a new evaluation is requested by the owner or owner's agent or is required according to local regulations. Additional Administrative Rule references for this activity can be found at Minn. R. 7082.0700, subp. 4 Items B, C, and D; 7083.0730 Item C. E Certificate of sewage tank compliance Affirm all three statements. ® The SSTS does not contain a seepage pit, cesspool, drywell, leaching pit, or other pit. ® It does not contain a sewage tank that was designed to be watertight, but subsequently leaks below the designed operating depth. It does not represent an imminent safety threat by reason of unsecured, damaged, or weak maintenance hole cover(s) or other unsafe condition. Company information Company name: Elmer J. Peterson Co. Business license number: 219 ❑ {notice of sewage tank non-compliance Select all that apply: ❑ The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit— "Failure to Protect Groundwater." ❑ It has a sewage tank that was designed to be watertight, but subsequently leaks below the designed operating depth —"Failure to Protect Groundwater." ❑ It presents a threat to public safety by reason of unsecured, damaged, or weak maintenance hole cover(s) or other unsafe condition — w"Imminent Threat to Public Health or Safety." Designated Certified Individual (DCI) information Print name: James L. Braegelmann. Certification number: 01113 1 personalty conducted the worts described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection, maintenance, installation, or service provider Business. t personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS. By typing/signing my name below, 1 certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this form. Designated Certified Individual's signature: James L. Braegelmann Date (mmiddlyyyy): (This document has been efectronicalty signed.) www.pca.state.mn.us 651-296-6360 806-657-3864 wq-wwists4-91 + 1/5121 2/18/2021 Use your preferred relay service Available in alternative formats Page 1 of 1 Sail Observation Log www.SeptieResource.com vers 12.4 Owner Information Property Owner / project: Nancy Thompson Date 2/19/2021 Property Address / PID: 2880 Fox 'Street Soil Survey Information ❑ refer to attached soil survey Parent matl's: ❑ Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ summit ❑ Shoulder D Side slope ❑ Toe slope soil survey map units: L22C2 slope % direction- Lineal Soil Log #1 D Boring ❑ Pit Elevation 98.1 Depth to SHWT 16 Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-8 Topsoil <35 10yr3/1 Friable Moderate Blocky 8-16 Clay Loam <35 1Oyr4/3 Friable Strong Blocky 16-24 Clay Loam <35 1Oyr5/4 I Oy4/8,1-6/1 Oy Firm Strong Blocky <35 loose loose single grain 35-50 friable weak granular blocky firm moderate Prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive Comments: TBM: Top of basement concrete slab &a 77r II AW fl &a 77r II It &a