HomeMy WebLinkAbout10-05-2020 Septic Compliance Inspectiont• Minnesota Pollution
Control
AgAgency
Compliance Inspection Form
C
520 Lafayette tioad North Existing Subsurface Sewage Treatment Systems (SSTS)
St, Paul, MN 55155-4194 Doc Type; Compliance and Enforcement
Inspection results based on Minnesota Pollution Control Agency (MPCA) 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 16 days
System Status
System status on date (mmldd/yyyy): _10- S -2,o
Compliant — Certificate of Compliance
(Valid for 3 years from report date, unless shorter time
frame oullined in Local Ordinance.)
❑ Noncompliant — Notice of Noncompliance
(See Upgrade Requirements on page 3.)
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 113) — Imminent threat to public health and safety
❑ Tank Integrity (Compliance Component 112) — Failing to protect groundwater
Other Compliance Conditions (Compliance Component 03) —t=ailing to protect groundwater
❑ Soil Separation (Compliance Component #4) — Failing to protect groundwater
❑ Operating permittmonitoring plan requirements (Compliance Component #5) — Noncompliant
Property information Parcel 10# or Secfrwp/Range: i,} 1�1 1 `<.� &0.
Property address: aaiijc 0 p Gly n �5 ��.SG. 212QO Reason for inspection:
Property owner: 5c.,c��(•i 1 4. ��( iy�l_ Owner's phone: ��a-30S -) S1 al
or
Owner's representative: Representative phone:
Local regulatory authority: Regulatory authority phone; °1 S;t ko00
Brief system description; a - ofd v /y� p` `� c, �,✓„yMS' �Cv-+S�r t.10J}SQ
Comments or recommendations: 'rY; 4 IL�be` v1yt34T7 51z.t9p �o�rk c,�54:��i'nv�ryt opt f
Certification
I hereby certify that ail 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: ��:�/ ih\ (3 L�� � _ Certification number: _� )
Business name: License number: L.
Inspector signature: �j� a Phone number: V123
Necessary or Locally
® Soil boring logs
❑ Other information (1131):
Required Attachments
System/As-built drawing ❑ Forms per local ordinance
www.pca.state.mn.us 651.296-6300 - 800-657-3864 TTY 651.282-5332 or 800.657-3864 • Available in alternative formats
wq-wWWA-31b • 614114 Poop 1 of i
Property address: 2, (oo► O C SAX V.A-),4 Inspector initials/Date: � %o--1- as
(mm/dd/yyyy)
1. Impact on Public Health — Compliance component #1 of 5
Hance cri
System discharges sewage to the I ❑ Yes OR No
System discharges sewage to drain ❑ Yes H No
tile or surface waters.
System causes sewage backup into (❑ Yes Q No
dwelling or establishment.
Any "yes" answer above indicates the
system is an imminent threat to public
health and safety.
Comments/Explanation:
Verification method(s);
❑ Searched for surface outlet
Searched for seeping in yard/backup in home 1.,1C
Excessive ponding in soil system/D-boxes �_W
❑ Homeowner testimony (See Commentwaxplana(lon)
"Black soil" above soil dispersal system 140
❑ System requires "emergency" pumping
❑ Performed dye test
❑ Unable to verify (See Comments/Explanation)
❑ Other methods not listed (See Comments/Explanaton)
_2. Tank Integrity — Compliance component#2 of 5 _
Com liance criteria:
System consists of a seepage pit, ❑ Yes ❑ No
cesspool, dryweil, or leaching pit.
Seepage pits meeting 7080.2550 may be
compliant it allowed in local ordinance.
Sewage tank(s) leak below their ❑ Yes ❑ No
designed operating depth. '
If yes, which sewage tank(s) leaks:
Any "yes" answer above indicates the
system is failing to protect groundwater.
Camments/Explanation:
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 Comm ents/Explanation)
❑ Other methods not listed (See Comments/Explanation)
L
3. Other Compliance Conditions — Compliance component #3 of 5
a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. ❑ Yes* 0 No ❑ Unknown
b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. ❑ Yes* p No p Unknown
"System is an imminent threat to public health and safety.
Explain:
c. System is non -protective of ground water for other conditions as determined by inspector .
*System is failing to protect groundwater.
Explain:
www.pca.state,mn.us - 651-296-6300 800-657-3864 TTY 651.282-5332 or 800-657-3864
wq-wwists4.31b • 614114
❑ Yes* lid No
• Available in alternative formats
Property address: Al,�010 q �,��, .{�y�Inspector initial8IDate; ;��" IQ --e—,70
(mmlddlyyyy)
4. Soil Separation —Compliance component #4 of 5
Date Of installation: app oZ ❑ Unknown Verification method(s):
(mmlddlyyyy)
ShorelandNVei(head protectiontFood beverage Soil observation does not expire, Previous soil
lodging? Q Yes [B No observations by two independent parties are sufficient,
unless site Conditions have been altered orlocal
Compliance criteria: requirements differ.
For systems built prior to April 1, 1996, and Q Yes (] No
not located in Shoretand 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
Non-periormance systems built April 1. ® Yes Q No
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."
"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.
M Conducted soil observation(s) (Attach boring logs)
Q Two previous verifications (Attach boring logs)
Q Not applicable (Holding tank(s), no drainfield)
Q Unable to verify (See Comments/Explanation)
Q Other (See commentsiExplanation)
Comments/Explanation:
Indicate depths or elevations
A. Bottom of distribution media S. tis 'a • q, a a,a "
5'si�_ ,
B. Periodical!y saturated soil/bedrock s z l a -
5'i3ti 1- ,q
C• System separation yV, f A . g,7'
D. Required compliance separation" -�' o i
"May be reduced up to 15 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? Q Yes ❑ No If "yes", A below is required
Is the systam required to employ a Nitrogen BMP? Q Yes Q 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. Operating Permit number:
Have the Operating Permit requirements been met? ❑ Yes Q No
b. Is the required nitrogen BMP in place and properly functioning? _[] Yes .❑ No
Any "no" answer indicates Noncompliance,
Upgrade Requirements (Minn. Stal. 9 1 i5.53) An imminent threat to public health and safety (!TANS) must be upgraded, replaced, orits 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 few, and has at least two teat 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.
www.pca,state.mn.us • 651-296-6300 800-657-3864 TTY 651-282-5332 or 800-657.3864 • Available in alternative formats
wq-wwists4-3 ib • 614114
Property address: �2 & l V r3 ? cr- ie.,
City:
D ro Ac)
State: M
Parcel ID:
Zip code: Si
3:570
Optional section: Sewage Tank Compliance Certification
This form does not represent a complete system inspection report and only certifies sewage tank compliance status.
Instructions: This section of the form may be completed and signed by a Designated Certified Individual (DCI) of a licensed SSTS
Maintenance Business who personally conducts the necessary procedures to assess the compliance status of each sewage tank in
the system,
When this section of the 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 MPCA website at httos://www.t)ca..state,mn.us/water/ssts-and-msts-technical-and compliance criteria.
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 the inspection report. It 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.
ertificate of sewage tank compliance ❑ Notice of sewage tank non-compliance
Affirmail ree statements:
O'The SSTS does not contain a seepage pit, cesspool,
ell, leaching pit, or other pit.
It does not contain a sewage tank that was designed
to be watertight, but subsequently leaks below the
9sigrfed operating depth.
Olt does not represent an imminent safety threat by
reason of unsecured, damaged, or weak
maintenance hole covers) or other unsafe condition.
Company information
Company name: Duane's Septic Service
Business license number: 654
Select all that apply:
❑ The SSTS has a seepage pit, cesspool, drywell,
leaching pit, or other pit. }
Q It has a sewage tank that was designed to be
watertight, but subsequently leaks below the designed
operating depth.
❑ It presents a threat to public safety by reason of
unsecured, damaged, or weak maintenance hole
covers) or other unsafe condition. j
Designated Certified Individual (DCI) information
Print name: ) /� lc;✓'
Certification number: C2084
/persona//y conducted the work described above as a Designated CertifiedIndividual of Minnesota -licensed SSTS Maintenance
Business. / personally conducted cessary procedures to assess the compliance status of each sewage tank In this SSTS.
Designated Certified
Individual's signature: Date (mm/dd/yyyy):
www.pca.state.mn.us • 651-296-6300 800-657-3864
wq-wwists4-38 • 1127117
Use your preferred relay service Available in alternative formats
Poo I of 7
-P TESTING, INC. „ Steven B. Schirmers • MPCA Cert.No. 627
951 Katydid Lane NE - St. Michael, MN 55376 • (763) 497-3566
FAX (763) 4.97-5011
State License #394
wwwsptesting.wastewater@comeast.net - schirmerswastewater.com
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SP TESTING INC.
Steven B. Schirmers -951 Katydid Lane NE -St. Michael, MN 55376
Gert. No 627 - State License #394 - Phone 763-497-3566 - Fax 763-497-5011
www.sptesting.wastewater@comcast.net - schirmerswastewater.com
October 14, 2020
Scott Brekken
2690 Deer Run Trail
Orono, MN
A Compliance inspection was completed for the existing on-site sewage treatment
system located on this property for the sale of the home. The system consists of 2-
1000 gallon septic tanks, 1 -1000 gallon pump tank, a pressurizedmound system
with a 10' x 66' rock bed, built In 2002 for a 5 bedroom home.
Soil boring #1 found mottled soil (redox features) at 1.8' into the original soil & the
original soil at elev. 97.5 & the bottom of the rock bed at elev. 99.6 leaving 2.1' of
sand below the rock bed & a 3.9' separation from the bottom of the rock & redox
features. Soil boring #2 found mottled soil at 1.5' into the original soil & the original
soil at elev. 97.0 & the bottom of the rock bed at elev. 99.2 leaving 2.2' of sand & a
3.7' separation. This system meets the required 3' separation from the bottom of the
rock bed.
The tanks were pumped by Duane's Septic Service & were found to be compliant.
Nothing other than gray water (laundry, showers etc.) human waste & toilet tissue
should be disposed of into the septic tanks. Garbage disposals are not
recommended due to adding more solids & fine solids passing through into the
system. Iron filters are also not recommended & should be diverted out of the
system. Excessive amounts of soaps, antibacterial soaps, cleaning agents, shower
cleaners used every shower & chlorine agents may kill the bacteria you need living
in the system. Additives are not recommended. Recommend to pump & clean you
tanks through the manhole by a certified pumper every 2 years. Check with your
pumper to set up a schedule.
This certificate of compliance is no guarantee that this system will continue to
function indefinitely.
Steven B. Schirmers
SP TESTING INC.
Steven B. Schirmers -951 Katydid Lane NE -St. Michael, MN 55376
Cert. No 627 - State License #394 - Phone 763-497-3566 - Fax 763-497-5011
www.sDtestine.wastewater@comcast net— schirmerswastewater.com
Scott Brekken
2690 Deer Run Tr.
Orono, MN
Soil borings completed with a bucket auger on 10-5-20
SOIL BORING #1 - ELEV. 101.0 - MOTTLED SOIL PRESENT IN THE BORING
AT 1.8' Into the original soil.
0 - 16" Fill soil loam
16" - 42" fill soil medium sand
42" - 56" Original soil dark brown loam 10YR 3/2
56" - 64" Gray brown loam 10YR 4/1
6401 - 6800 Gray brown clay loam 10YR 6/2 - distinct mottles 10YR 6/8
SOIL BORING #2 - ELEV. 101.0- MOTTLED SOIL PRESENT IN THE BORING AT
1.51 into the original soil.
0 - 12" Fill soil loam
12" - 48" Fill soil medium sand
48" - 66" Original soil very dark gray loam 10YR 2/1
66" - 72" Dark gray clay loam 10YR 4/2 -distinct mottles 10YR 618