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Home My WebLink About08-26-2021 Septic Compliance ReportM MINNESOTA POLLUTION Compnliance inspection report form CONTROL AGENCY N I" 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 (MPGA) website at https:/Iwww.pca.state.mn us/sites/default/files/wa-wwists4-31a pdf. Property information Local tracking number Parcel ID# or Sec/Twp/Range: 1011723220012 Reason for Inspection Property Transfer Local regulatory authority info: City of Orono Property address: 2250 French Lake Road Owner/representative: Mark Erpelding Owner's phone: 952-797-6968 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 (mm/dd/yyyy): 8/26/2021 ® 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. 7880.1500 as of system status date above and does not guarantee future performance. El 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 (1TPNS) 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) — Faking 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. 7030.2500 (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 1.7 feet of sand on the East side and 2.0 feet of sand on the West 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: Rugy Olson Soil & percolation Testing Certification number: 01255 Inspector signature: _Joseph J. Olson License number: L810 (This document has been electronically signed) Phone: 763-498-8779 Necessary or locally required supporting documentation (must be attached) 0 Soil observation logs ® System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit ❑ Other information (list): https://www.pca.state.mn.us • 651-296-6300 800-657-3864 wq-ww1sts4-31b • 4/28/2021 Use your preferred relay service Available in alternative formats Page I of 4 Property Address: 2250 French Lake Road Business Name: Rusty Olson Soil & percolation Testing Date: 8/26/2021 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' 10 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 Attached supporting documentation: ❑ Other: �J 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? ❑ Yes' 10 No 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: Elmer J Peterson Company pumped the tanks. 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 8/23/2021 (mm/dd/yyyy): (must be within three years) (See form instructions to ensure assessment complies with Minn. R. 7082.0700 subp. 4 8 (9)) ❑ 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 wq-wwists4-31b • 4/28/2021 Page 2of4 Property Address: 2250 French Lake Road Business Name: Rusty Olson Soil & percolation Testing pate: 8/26/2029 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* ® No *Yes to 3c or 3d - System is failing to protect groundwater. Describe verification methods and results: Visual. Nothing was found Attached supporting documentation: ID Not applicable ❑ 4. Operating permit and nitrogen BMP* — Compliance component #4 of 5 E 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 wp-wwists4-31b • 4/28/2021 Page 3of4 Property Address: 2250 French Lake Road Business Name: Rusty Olson Soil & percolation Testing Date: 8126/2021 5. Soil separation — Compliance component #5 of 5 Date of installation 11/17/2009 (Mmlddlyyyy) Shoreland/Wel Ihead protection/Food beverage lodging? Compliance criteria (select one): ❑ Unknown � ■ 5a. 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: Drainfield has at least a two -foot vertical separation distance from periodically saturated soil or bedrock. 5b. Non-performance systems built ® Yes ❑ No* 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.* 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 (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: Attached supporting documentation: ❑ Soil observation logs completed for the report ❑ Two previous verifications of required vertical separation ❑ Not applicable (No soil treatment area) Indicate deaths or elevations A. Bottom of distribution media 102.3 B. Periodically saturated soil/bedrock 99.4 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 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 4/2812021 Page 4cf4 Tank Re art Elmer J. Peterson Co. 5921 Dague Ave. Deland, MN 55328 Phone 768-972-2420 Fax 763-972-7217 MPCA License# 21.9 Mark Erpelding 2250 French Lake Road Wayzata, MN 952-797-6968 Baffles: (DN / Tank Capacity: # of Tanks: 3 OFF 3-1000 Gallon Tanks Type of Tanks: Concrete Gallons Pumped: 2500 Manholes to Grade: YES / NO Comments: Date: August 23,!2021 On August 23, 2021, Eimer J. Peterson Co. uncovered 1st & 2nd manholes (both 8" deep) and pumped septic 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 integrity assessment form CONTROL AGENCY 520 Lafayette Road North Subsurface Sewage 5t. Paul, MN 55155-4194 Treatment Systems (SETS) Program Doc Type: Compliance and Enforcement 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: hftps://www.pca.state.mn.uslwaterlinsipections. 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. Only a licensed maintenance business is authorized to pump the tank for assessment. 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 (wq-wwists4-31 b). This form can be found on the MPGA website at httpsd/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(B)(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(B),(C), and (D) and; Minn. R. 7083.0730(C). Owner information Owner/Representative Mark Erpelding Property address: 2250 French Lake_ Road, Wayzata, MN Local Regulatory Authority: Parcel ID: System status System status on date (mmldd/yyyy): 8123/2021 ® Certificate of sewage tank compliance ❑ Notice of sewage tank non-compliance Compliance criteria: The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit - "Failure to Protect Groundwater." ❑ Yes:' 0 No The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect ❑ Yes" ® No Groundwater." The SSTS presents a threat to public safety by reason of structurally unsound (damaged, cracked, or weak) maintenance hole cover(s) or lids or any other unsafe condition - "Imminent Threat to Public Health or Safety." Any "yes" answer above indicates sewage tank non-compfiance, Company information 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, l 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): 8/23/2021 (This document has been electronically signed.) www.pca.state.mn.us wg-wwists4-91 • 5110/21 651-296-6300 • 800-657-3864 • Use your preferred relay service Available in alternative formats Page 1 of 1 Soil Observation Log www.SepticResource.com vers 12.4 Owner Information Property Owner / project: Mark Erpelding Date 8/26/2021 Property Address / PID: 2250 French Lake Road Soil Survey Information ❑ refer to attached soil survey Parent matl's: R] Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ Summit ❑ Shoulder 21 Side slope ❑ Toe slope soil survey map units: L22C:2 slope % direction - Soil Log 41 0 Boring ❑ pit Elevation 97.6 Depth to SHWT 16 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-10 Topsoil <35 1OW2/I Friable Strong Blocky 10-16 Clay Loam 1 O r4/3 friable Strong Blocky <35 loose loose single grain 35-50 friable weak granular blocky >50 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 <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive Comments: TBM: Top of the basement door threshold. ELV.-100.0 2250 French Lake Road Soil Log #2 21 Boring ❑ Pit Elevation 103.7 Depth to SHWT 48 inches Depth (in) Texture fragment %6 matrix color redox color consistence grade shape 0-34 Mound sand Fill <35 Loose Loose Single grain 34-38 Topsoil <35 10yr3/2 Friable Strong Blocky 38-48 Clay Loam <35 10yr5/4 Friable Strong l3locky 48-54 Clay Loam <35 1 Oyr5/4 l Oy4/8,1-611 Oy Firm Strong Blocky <35 loose loose single grain 35-50 friable weak granular blocky >50 film moderate prismatic platy rigid strong massive 2250 French Lake Road Soil Log #3 ❑ 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 >50 firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky 750 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 <35 loose loose single grain 35-50 friable weak granular blocky >50 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 hereby cerciv this work was completed in accordance with MN 4es�ie�rignature 7080 and any local reqs. Rusty Olsoes Soil & Perc Company 810 License # CITY OF n 12 a 1U 0 WORKSHEET FOR SEWAGE DISPOSAL WORK Date ii —/ 7 - 0 �' _ Inspector I jJ j ('e_ CO), db -5- Building Permit No, Z 00"'1 - �y Ofv Owner—_i) Qj49 4 kcp -4n i,, !'mss rv-, --e Property Address 7- 2-5-0 _ L 4 Kind of Building S F b SSTS Installer 0 (, i4&,5 4 S a -y% 5 d- 5 l?�+ t^License # & Septic Tanks ai+# Material Ga'Ytie- i AJ./ta 1,C} s 41,A�4^ Number of Tanks � Size 3-1000 Drain Field: /,, j Cvpt flp -- Total length of lines '7'r, Number of lines Type of soil t3 f4 cicr Percolation Test 5 i P ; T�e 5 fi`► Width of trench Type of filter material_. Icece 9 b el C - Size of Rock Bed 4C2 jC 5Z) Size of Absorption Area q Z , K 4;, Draw detailed diagram with measurements Indicating distances to septic tank risers from a permanent structure. S801- we 801- G,p . Erik fi33t -AfiA J r ( oast 3a' pU� p%j ArT ,AIgk ,.. j o oc� y C'rr w- )".+"+ s is 4--; o'j