Loading...
HomeMy WebLinkAbout08/11/2021 Septic Compliance InspectionMINNESOTA POLLUTION Compliance inspection report form CONTROL AGENCY p N 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) St. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement Instructions: Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final determination of compliance or noncompliance. Instructions for filling out this form are located on the Minnesota Pollution Control Agency (MPCA) website at https://www.pca.state.mn.us/sites/defaulilfiles/wo-wwists4-31a.odf. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: 061.1723140019 Reason for Inspection Property Transfer Local regulatory authority info: City of Orono Property address: 4165 Bayside Road Owner/representative: Brian Benson Owner's phone: 612-227-8629 Brief system description: 2 -1000 -gallon septic tanks, 1 -1000 -gallon lift station and 500 square feet of mound rock bed System status System status on date (mmldd/yyyy): 8/11/2021 ® 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 Systems failing to protect ground water must be upgraded, replaced, or use discontinued within the time required by local ordinance. 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. 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 The system is designed for a four bedroom house. There is 1.0 feet of sand on the North side and 2.2 feet of sand on the South side under the rock bed. 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. Soil & percolation Testing Certification number: C1255 Inspector signature: Joseph J. Olson (This document has been electronically signed) License number: L810 Necessary or locally required supporting documentation (must be attached) Phone: 763-498-8779 2 Soil observation logs System/As-Built ❑ Locally required forms Z Tank Integrity Assessment ❑ Operating Permit ❑ Other information (list): https://www.pca.state.mn.us 651-296-6300 806-657-3864 wq-wwi5ts4-31b • 4/28/2021 Use your preferred relay service Available in alternative formats Page 1 of 4 Property Address: 4165 Bayside Road Business Name: Rusty Olson Soil & percolation Testinq 1. Impact on public health — Compliance component #1 of 5 Compliance criteria: System discharges sewage to the C1 Yes' 0 No ground surface System discharges sewage to drain ❑ Yes' ® 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: Visual. Nothing was found Date: 8/11/2021 Attached supporting documentation: El Other: ® Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes` Z No cesspool, drywell, leaching pit, or other it? Sewage tank(s) leak below their ❑ Yes" ®No designed operating depth? If yes, which sewage tanks leaks: Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Duane's Septic Service pumped the tanks. httpss//www.pca.state.mn.us 651-296-6300 800-657-3864 wg-wwists4-31b • 412812021 Attached supporting documentation: ❑ Empty tank(s) viewed by inspector Name of maintenance business: License number of maintenance business: Date of maintenance: ® Existing tank integrity assessment (Attach) Date of maintenance 8/5/2021 (mmidd/yyyy): (must be within three years) (See fonn instructions to ensure assessment complies with Minn. R. 7082.0700 subp. 4 B (1)) ❑ Tank is Noncompliant (pumping not necessary - explain below) ❑ Other: Use your preferred relay service Available in alternative formats Page 2 of 4 Property Address: 4165 Bayside Road Business Name: Rusty Olson Soil & percolation Testing Date: 8/11/2021 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' E 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' ® No *Yes to 3c or 3d - System is falling to protect groundwater. Describe verification methods and results: Visual. Nothing was found Attached supporting documentation: [R 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 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 • 4/28/2021 Page 3 of 4 Property Address: 4165 Bayside Road Business Name: Rusts+ Olson Soil & percolation Testing ^� S. Soil separation — Compliance component #5 of 5 Date of installation 1117/1988 ❑ Unknown (mm/dd/yyyy) Date: 8/11/2021 Shoreland/Wellhead protection/Food ❑ Yes ❑ No Attached supporting documentation: beverage lodging? ® Soil observation logs completed for the report Compliance criteria select one): ❑ Two previous verifications of required vertical separation 5a. For systems built prior to April 1, 1996, 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-perfornrance 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.* ❑ Yes ❑ No* ❑ Not applicable (No soil treatment area) ® Yes ❑ No* Indicate deaths or e 5c. "Experimental", "Other", or "Performance" [:]Yes ❑ No* systems built under pre -2008 Rules; Type 1V or V systems built under 2008 Rules 7080. 2350 or 7080.2400 (Intermediate Inspector License required <_ 2,500 gallons per day; Advanced Inspector License required > 2,500 gallons per day) 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 105.4 B. Periodically saturated soil/bedrock 102.4 C. System separation 3.0 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 651-296-6300 800-657-3864 Use your preferred relay service • Available in alternative formats wq-wwist54-31b • 412812021 Page 4 of4 MINNESOTA POLLUTION Sewage tank integrity assessment form CONTROL �AGENC �7 b 1 524 Lafayette Road North Subsurface Sewage St. Paul, MN 55155-4144 Treatment Systems (SSTS) Program t] Properly address: SOLY'st 6L<— RK Parcel ID:----- City: D:___City: o (`0 %ry 6 State: Zip code: 3 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: M1111 sJ/www-Dca.state mn.us/tivaner'in�ctint�s. 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: !�orfrpEiance ?ns:ection form - Existinsystern (Kjg_,�Pt+r�ists4-31? h - This form can be found on the MPGA website at lrts_Ihvww.nca stat`e.mn+slw•!aterlins�aetiar�. The information and certified statement on this farm 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. 7482.0700, subp. 4 Item (B) subitern ('i). 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. ..ertificate of sewage tank compliance Affirm al a statements: he SSTS does not contain a seepage pit, cesspool, dDAvall, leaching pit, or other pit. It does not contain a sewage tank that was designed to be watertight, but subsequently leaks below the d d operating depth. - t 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: Duane's Septic Service Business license number: 654 0 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 f(DCI) information Print name: l f �%a� Certification number: L 5? -/'-7 Z_ I personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection, maintenance, installation, or service provider Business. 1 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 th urpose ofnpracess. this form. Designated Certified Individual's signature: _ .y' Date (mmldd/yyyy): (This ocument has been electronically signed.) www.pca.state.mn.us wq-ww15ts4-91 • 1/5/21 651.296-6300 • 800-657-3864 . Use your preferred relay service • Available in alternative formats Page I of I Property Owner / project: Property Address / PID: Soil Observation Log www.SepticResource.com vers 12.4 Owner Information Steven Netishen 4165 Bayside Road Date 8/11/2021 Soil Survey Information ❑ refer to attached soil survey Parent matl's: ❑ Till ❑ Qutwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ Summit 0 Shoulder ❑ Side slope ❑ Toe slope soil survey map units: L41C2 2 slope % direction- Lineal Soil Log #1 Z Boring ❑ pit Elevation 106.8 Depth to SHWT 50 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape loose loose single grain 0-26 Fill mound sand <35 friable weak granular blocky firm moderate prismatic platy rigid strong massive 26-36 Loam <35 10yr3/1 Friable Strong Blocky 36-40 Clay Loam <35 10yr4/3 Friable Strong Blocky 40-50 Clay Loam <3 IOyr5/4 Friable Strong Blocky 50-56 Clay Loam <35 10yr5/4 10y4/8,1 -6/10y Firm Strong Blocky Comments: 4165 Bayside Road Soil Log 42 ❑ Boring ❑ Pit Elevation 106.2 Depth to SHWT 48 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape loose loose single grain 0-36 Fill mound sand <35 friable weak granular blocky firm moderate prismatic platy rigid strong massive 36-48 Topsoil <35 10yr3/1 Friable Moderate 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 <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive 4165 Bayside Road Soil Log 43 RI Boring ❑ Pit Elevation Depth to SHWT Depth (in) Texture fragment % matrix color redox color consistence grade shape <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive < 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 <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 >50 firm moderate prismatic platy rigid strong massive I hereby certify this work was completed in accordance with MN 7050 and any local reqs, Rusty Olson's Soil & Perc 810 esigner Signature Company License # �1�5- Barlide- V, 5W4 A `T'oh mwihat& cvr. 3q I VAT yD'7 7;-Iij q3 4o,(o Oar qq'� aKr G Q fl 1