HomeMy WebLinkAbout09/06/2018 Septic Compliance24910 Territorial Road, Rogers, Minnesota 55374 • 763.428-4489
into@endeseptic.com • www.endeseptic.corn
Project: 15o North Shore Dr. Orono, MN
A septic compliance inspection was completed and the system is
Compliant according to the MPCA codes for the Chapter 7080
and local codes for the City of Orono in Hennepin County. The
system has the following attributes:
Date Home Built: 1998
Bedrooms: 4
Date Septic Built: 1998
Septic Tanks: 2-1000 gallon precast septic tank, manhole covers to grade.
Inlet and outlet baffles in place.
Pump Tank: l000 gallon precast tank, manhole cover to grade.
Soil Treatment: 1o'x37.5' rockbed, 12 inch sand lift, pressure fed mound.
Problems Identified: The mound is only a 3 bedrooms system and the
house has 4 bedrooms.
Ende Septic Service, LLC, has been hired to perform a compliance inspection of your ISTS for
compliance with local ordinances pursuant to Minn. State. Sec. 155.55 (2010). The compliance inspection
covers only the criteria required by Minn. Stat. Sec. 155.55, Subd. 5a (2010 and Minn. R. 7080.1500 (2011).
A Compliance inspection is a snapshot in time of your septic system and does not warrant the condition or
longevity of your septic system. Ende Septic Service, LLC, disclaims any use of the compliance inspection
beyond determining SSTS compliance pursuant to Minn. Stat. Sec. 155.55 (2010).
Minnesota Pollution Compliance Inspection Form
Control Agency
Control
Subsurface Sewage Treatment Systems (SSTS)
520 Lafayette Road North
St. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement
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 (mm/ddlyyyy): 9/6/2018
® 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 114) — Failing to protect groundwater
❑ Operating permit/monitoring plan requirements (Compliance Component #5) — Noncompliant
Property Information Parcel ID# or Sec/Twp/Range: 06-117-23-22-0023
Property address: 150 North Shore Dr. W Orono, MN Reason for inspection: Property T ansfer
Property owner: Steve Dzubay _ _ Owner's phone:
or
Owner's representative: Eric Beise Representative phone: 507-696-4246
Local regulatory authority: City of Orono _ Regulatory authority phone: 952-249-4600 _
Brief system description: 2-1000 gallon septic tanks and a 1000c alion pump tank to a pressure fed mound
Comments or recommendations:
Mound has a 12 inch sand lift with a 10'x37.5' rockbed.
Certification
l 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: Tristan Ende_ _ _ _ Certification number: C9206
Business name: Ende Service _ -_ License number: _ L2654___ __ _
Inspector signatur Phone number: 763-428-4489
Necessary or Locally Required Attachments
® Soil boring logs ® System/As-built drawing ❑ Forms per local ordinance
❑ Other information (list):---
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Property address: 150 North Shore Dr. W Orono MN Inspector initials/Date: 1 1 91M018
(mmkid1yM)
1. Impact on Public Health — Compliance comQonent #1 of 5
System discharges sewage to the I ❑ Yes ® No
System discharges sewage to drain I C] Yes ® No
System causes sewage backup into I ❑ Yes ® No
dwelling or establishment. 1
Any "yes" answer above indicates the
system is an imminent threat to public
health and safety.
Comments/Explanation:
2. Tank Integrity — Compliance component #2 of 5
ice criteria:
System consists of a seepage pit, ❑ Yes ® No
cesspool, drywell, or teaching pit.
Seepage pits meeting 7080.2550 may be
cwwAant if allowed in kcal ordinance.
Sewage tank(s) leak below their 0 Yes ® No
designed operating depth.
If yes, which sewage tank(s) leaks:
Any "yes" answer above indicates the
system is failing to protect groundwater.
Comments/Explanation:
Verification method(s):
❑ Searched for surface outlet
® Searched for seeping in yard/backup in home
❑ Excessive ponding in soil system/D-boxes
❑ Homeowner testimony (see CommentsExptanation)
F-1 "Black soil" above soil dispersal system
❑ System requires "emergency" pumping
❑ Performed dye test
❑ Unable to verify (See CommenWExpAwatbn)
❑ Other methods not listed (See Commenbl&pianation)
Verification method(s):
❑ Probed tank(s) bottom
❑ Examined construction records
❑ Examined Tank Integrity Form (Attach)
❑ Observed liquid level below operating depth
® Examined empty (pumped) tanks(s)
❑ Probed outside tank(s) for "black soil"
❑ Unable to verify (See CommenW&planatbn)
❑ Other methods not listed (See CommenWExplanatbn)
3. Other Compliance Conditions -- Compliance component_#3 of 5
a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. O Yes" ® No D Unknown
b. Other issues (ebcftWhazan*, eic.) to immediately and adversely impact public health or safety. ❑ YW R No ❑ Unknown
'System is an jmm&ww threat to public health and safety.
Explain:
c. System is non -protective of ground water for other conditions as determined by inspector. CI Yes" ® No
"System is WAIV to protectWwndWater.
Explain:
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Property address: 150 North Shore Dr. W Orono, MN Inspector initials/Date: 9/6/2018
(mrNddhryyy)
_4. Soil Separation — Compliance component #4 of 5
Date of installation: 1/1/1998 ❑ Unknown Verification method(s):
(mmfdd'yyyy) Soil observation does not expire. Previous soil
ShorelamMelibeed protection/Food beverage ❑ Yes ® No observations by two independent parties are suftient,
lodging? unless site conditions have been altered orlocal
Compliance criteria: _ _._ requirements differ.
For systems built prior to April 1, 1996, and ❑ Yes ❑ No
not located in Shoreland or Wellhead
Protection Area or not serving a food,
beverage or lodging establishment:
Drainfieid has at least a two -foot vertical
separation distance from periodically
saturated soil or bedrock.
Non performance systems built April 1, ® Yes ❑ No
1996, or later or for non-performance
systems located in Shoreland or Wellhead
Protection Areas or serving a food,
beverage, or lodging establishment:
Drainfieid has a three-foot vertical
separation distance from periodically
saturated soil or bedrock."
°Experimental", "Other", or "Performance" ❑ Yes ❑ No
systems burl under pre -2008 Rules; Type IV
or V systems buAt 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.
® Conducted soil observation(s) (Attach boring logs)
❑ Two previous verifications (Attach boring togs)
❑ Not applicable (Hokting tank(s), no drain/tekg
❑ Unable to verify (See CommerrW&ptanation)
❑ Other (See Comments/Explanation)
Comments/Explanation:
Indicate deaths or elevations
A. Bottom of distribution media
12"
B. Periodically saturated soillbedrock
-24"
C. System separation
36"
D. Required compliance separation*
36"
'May be reduced up to 16 percent if allowed by local
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? Q Yes ❑ No If "yes", B below is required
BMP = Best Management Pradice(s) specified in the system design
K the answer to both questions /s "no", this section does not need to be completed.
a. Operating Permit number: 10 Yes ❑ No
Any "no" answer indicates Noncompliance.
Upgrade Requirements (Minn. Stat § 115.55) An imminent threat to public health and satiety (f7PHS) must be upgraded, replaced, or its use
discontinued within ten months of receipt of this notim or within a shorter perbd if requbed 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 boat ordinance. if an existing system
is not failing as defused in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, mphwed or
its use discontinued, notwithstanding any local ordinance that is more strict This provision does not appy to systems in shore/and areas,
Wellhead Protection Argas, or those used in connection with food, beverage, and lodging establishments as defined in law.
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 TTY 651-282-5332 or 80D-657-3864 • Available in attemattve formats
wq•wwists4-31b • 614114 Page 3 of 3
PROPERTY ADDRESS:
150 NORTH SHORE DR.
ORONO, MN
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Reporting Information
Date of maintenance:
Property address:
Property owner's nanL:
Property -owner's address if different:
City: State:
Reason for maintenance�a t .
.��
-...__. City: c`v z Stater Zip:
Zip: Phone:
Fax:
1. Access used to remove septage: C. Maintenance hole ❑ Other (Go to #3 below)
2. If maintenance hole was used, were all covers securely replaced? Yes ❑ No please explain
Explanation:
3, If owner refuses to allow a Subsurface Sewage Treatment System (SSTS) to be pumped through the maintenance hole,
have them complete and sign the following statement.
I, ___, refuse to allow the removal of the solids and liquids through the maintenance
(Owner's name) _ -
hole. I understand that removal of solids and liquids through other access points is not considered maintenance.
Owner's signature: Date:
4. Is the tank designed as a leaky tank? (Example: seepage pit,. cesspo¢ , drywell, leaching pit)
Tank #1: ❑ Yes V No Verification method used?
Tank #2: ❑ Yes No Verification method used?
5. Is there evidence of tank leakage from a septic, holding, pretreatment or pump tank below the operating depth or
evidence of damaged, cracked or structurally unsound maintenance hole covers?
Tank Leaking out ! Leaking in Cover damage
Septic/hQldin Tank #1 E Yes �9 No ❑ Yes No I E]Yes bg No
------- ---
Se�ticlholdingTank #2 i El No _ El Yes No f Yes No
Pretreatment Tank ❑ Yes ❑ No ❑ Yes ❑ No ❑Yes ❑ No
Pump Tank ❑Yes �(] No ❑ Yes No ❑ Yes No
6. How many gallons of septage were removed?
Tank #0\n'\') Tank #2: } v�� Pretreatment Tank: Pump Tank
7.
Is there any sensory (smell and/or sight) evidence of non-domestic wastes?
❑ Yes �[-!'§P'No Please explain:
Disposal site: \C] Wastewater treatment plant ❑ Land application ❑ Other (please explain below)
Explanation:
List any troubleshooting, minor repairs conducted, tank safety* concerns or other concerns:
B. Certification: I hereby certify as a State of Minnesota -certified SSTS Maintainer that I personally conducted the work and
made the observations, or directly supervised others in the performance of this job.
Maintainer's name and address: C`35
Maintainer's license Maintainer's phone:
Maintainer's signature: `i`a� DateN���\R
i
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