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HomeMy WebLinkAbout05/05/2021 Septic Compliance Reportre ection MINNESOTA POLLUTION Com liance ins ort form I CONTROL AGENCY p p p 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 (MPCA) requirements and attached supporting documentation — additional local requirements may also apply. Further information can be found here: https://www.pca.state.mn.us/sites/defauf/files/wq-wwists4-31a pdf. 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 trackino number Parcel ID# or Sec/Twp/Range: 33-118-23-44-0040 Local regulatory authority: City of Orono 952-249-4613 Property address: 155 Truffula Trail, Orono MN 55356 Owner/representative: Amanda Re -Max Adv. Plus Owner's phone: 720-333-4868 Brief system description: Pre -cast Septic tanks and an above Grade Drainfield System status System status on date (mm/dd/yyyy): 5/5/2021 ® Compliant — Certificate of compliance* (Valid for 3 years from report date unless evidence of an imminent threat to public health or safety requiring removal and abatement under section 145A. 04, subdivision 8 is discovered or a shorter time frame exists in Local Ordinance.) *Note: Compliance indicates conformance with Minn. R. 7080.1500 as of system status date above and does not guarantee future performance. ❑ Noncompliant — Notice of noncompliance 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 or under section 145A.04 subdivision 8. Systems failing to protect ground water must be upgraded, replaced, or use discontinued within the time required by local ordinance. 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 ❑ 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 (2) 1000 gallon pre -cast septic tanks, (1) 1000 gallon pump tank and a 10x50 Above Grade Drainfield. Pump tanks every 2-3 year to maintain the integerty of the drainfield. 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: Ch' _ 'tiLrSet ' e LLC Certification number: Inspector signature: License number: 2064 (This document has been electronically signed) Phone: 952-200-3176 Necessary or locally required supporting documentation (must be attached) ® Soil observation logs ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit ❑ Other information (list): https://www.pca.state.mn.us 651-296-6300 800-657-3864 wq-wwists4-31b • 1/11/21 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* ® No tile or surface waters. System causes sewage backup intoI ElYes* ® No dwelling or establishment. Any "yes" answer above indicates the system is an imminent threat to public health and safe Describe verification methods and results: Ran pump to determine hydraulic loading Attached supporting documentation: ❑ Other: ❑ Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes* ® No _ cesspool, drywell, leaching pit, or other pit? Sewage tank(s) leak below their ❑ Yes' ® No designed operating depth? If yes, which sewage tank(§) leaks: Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Tanks were pumped and inspected by others Attached supporting documentation: ® Pumped at time of inspection Elmer J. Name of maintenance business: Peterson Co License number of maintenance business: 219 Date of maintenance: 5/3/2021 ❑ Existing tank integrity assessment (Attach) Date of maintenance (mm/dd/yyyy): (must be within three years) (See form instructions to ensure assessment complies with Minn. R. 7082.0700 subp. 4 B (1)) ❑ Tank is Noncompliant (pumping not necessary - explain below) ❑ Other: https://www.pca.state.mn.us 651-296-6300 800-657-3864 • Use your preferred relay service Available in alternative formats wp-wwists4-31b • 1/11/21 Page 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* ® 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* ® No 3d. System not abandoned in accordance with Minn. R. 7080.2500? *Yes to 3c or 3d - System is failing to protect groundwater. Describe verification methods and results: Visual Attached supporting documentation: ❑ Not applicable ❑ Yes* ® No 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 If 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 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 1/11/21 Page 3 of 4 S. Soil separation — Compliance component #5 of 5 Date of installation 2/13/1997 ❑ Unknown (mm/dd/yyyy) Shoreland/WelIhead protection/Food ] Yes ® No beverage lodging? Compliance criteria (select one): 5a. For systems built prior to April 1, 1996, and not located in Shore/and 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 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.* ❑ Yes ❑ No* 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 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: A. Bottom of distribution media 12 inches of sand B. Periodically_ saturated soil/bedrock 124 inches la] Winches D. Required compliance separation* 1 31 inches *May be reduced up to 15 percent if allowed by Local Ordinance. Soil probe was used to determine depth of the soils and rock in drainfield. 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 800-657-3864 • Use your preferred relay service Available in alternative formats Page 4 of 4 - —rr . •A -:.'/ Soil Log #I �S onng ❑ Pit Elevation Depth to SHWT Depth (in) Texture fragment % matrix color redox color consistence grade shape loose loose single grain friable weak granular blocky >50 1 ��—Z firm moderate prismatic platy massive rigid strong loose loose single grain 35-50 friable firm weak granular blocky prismatic >50 moderate platy rigid strong massive SC , loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive � �C loose loose single grain 35 - 50 - 50 >50 y �j,/Z friable firm weak moderate granular blocky prismatic platy rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive Soil Log #:� ., ring ❑ Pit Elevation Depth to SHWT 061. Depth (in) Texture fragment % matrix color redox color consistence grade shape <3 loose loose single grain 35 - 50 friable weak granular blocky f� ��Z / ,� >50 / f 3" Z firm moderate prismatic platy massive `� `��"' ! rigid strong (<-35 loose loose single grain 35 -50 friable weak granular blocky >50[ / firm moderate prismatic platy rigid strong massive 65P loose loose single grain 35 -50 friable weak granular blocky >50 firm moderate prismatic platy / rigid strong massive �Sfq�_ 1 loose loose single grain 35-50 friable weak granular blocky >50 y / C firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35 -50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive I hereb certify this work was completed in accordance with MN 7080 and any local reqs. Chip Septic Servies LLC 2064 License #810 Location or Project: 155 Truffala Trail Borings made by: Rusty Olson's Soil and Per: twWng 11/29/2011 Classification System: AASHO USDS, USDS-SCS X_; Unified__; Other Auger used (check two): Hand �X`, or Power , Flight, Bucket or Probe !-X� Bench mark is top of basement concrete slab. Elv.-100.00 Assumed Boring Number _1 _ Surface elevation 95.8 0"-8" Dark brown loam 10yr3/2 8"-16" Brown loam 10yr4/4 16"-22- Brown loam 10yr5/4 22"-24" Broom loam 10yr514 loring Number 2 Surface elevation _95.8_ 1"-12" Fill 1"-12" Dark brown loam 10yr3/2 2"-22" Brown loam 10y 414 2"-30" Brown loam 10yr5/4 V-36" Brown loam 10yr514 Top of electrical box Elv.-100.00 assumed Kn of rock Elv.-96.8 nal grade Elv: 95.8 e is 1.0 feet of sand under the rock Mottled Soil at — 2.0_, feet H2O preserd at _X Mottled Soil aL3.Ow feet H2O present at __X_ IS5 7-yvffv/,2 -Fri Q0 coy � 1 IS5 7-yvffv/,2 -Fri Q0 coy (©� � cock-o'co -9.11 L�� tc s -v,- IN Ic Ids � TOu-i-- 3:3!3 &A 3s, 73 �1N- 4/3b 39, (©� � cock-o'co -9.11 L�� tc s -v,- IN Ic Ids Tank Report Date: May 3, 2021 Elmer J. Peterson Co. 5921 Dague Ave. Delano, MN 55828 Phone 763-972-2420 Fax 763-972-7217 MPCA License# 219 Jeff Staggs 155 Truffula Trail Orono, MN 55356 720-333-4869 Amanda — ReMax Adv. Plus Baffles: ON / OFF Tank Capacity: 3-1000 Gallon Tanks Per City Records # of Tanks: 3 Type of Tanks: Concrete Gallons Pumped: 3000 Manholes to Grade: YES / NO Comments: On May 3, 2021, Elmer J. Peterson Co. pumped tanks. No cracks or water leaking in tanks at the time of pumping. Note of Concern: Tanks starting to rot. 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 Y e tank integrity assessment form �� CONTROL AGENCY b 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: https://www.i)c;a.state.mn.us/water/inspections. 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 (wg-wwists4-31 b). This form can be found on the MPCA website at https://www.uca.state.mn.us/waterrinspections. 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. ® 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 ❑ 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 Company name: Elmer J. Peterson Co. Print name: James L. Braegelmann Business license number: 219 Certification number: 1 personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection, maintenance, installation, or service provider Business. I personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS. By typing/signing 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. Designated Certified Individual's signature: James L. Braegelmann _ Date (mm/dd/yyyy): 5/3/2021 (This document has been electronically signed.) www.pca.state.mn.us wq-wwists4-91 • 1/5/21 • 651-296-6300 • 800-657-3864 Use your preferred relay service Available in alternative formats Page 1 of 1 Tank Report Date: May 3, 2021 Elmer J. Peterson Co. 5921 Dague Ave. Delano, MN 55328 Phone 763-972-2420 Fax 763-972-7217 MPCA License# 219 Jeff Staggs 155 Truffula Trail Orono, MN 55356 720-333-4869 Amanda — ReMax Adv. Pius Baffles: r6N)/ OFF 3-1000 Gallon Tanks Per City Records Tank Capacity: # of Tanks: 3 Type of Tanks: _ Gallons Pumped: Concrete 3000 Manholes to Grade: YES 1 NO Comments: On May 3, 2021, Elmer J. Peterson Co. pumped tanks. No cracks or water leaking in tanks at the time of pumping. Note of Concern: Tanks starting to rot. NOTE: This is only a tank report. This is not a compliance inspection for point of sale nor does it replace a compliance inspection. M MINNESOTA POLLUTION Sewage tank integrity assessment 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: https://www.oca,state,i,nn.us/water/inspections. 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 farm - Existing system (wct-vrwists4-31 0. This form can be found on the MPCA website at htjps: ustate.r n.us/water/innspectipna. 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. ® Certificate of sewage tank compliance ❑ Notice of sewage tank non-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 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: I personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection, maintenance, installation, or service provider Business. I personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS. By typing/signing 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. Designated Certified Individual's signature: James L. Braegelmann Date (mm/dd/yyyy): (This document has been electronically signed.) www.pca.state.mn.us wq-wwists4-91 • 1/5/21 • 651-296-6300 • 800-657-3864 • Use your preferred relay service 5/3/2021 Available in alternative formats Page 1 of I