Loading...
HomeMy WebLinkAbout07/05/2020 Septic Compliance InspectionMinnesota Pollution Compliance Inspection Form Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems St. Paul, MN 55155-4194 (SSTS) Doc Type: Compliance and Enforcement Instructions: Inspection results based on Minnesota Pollution Control Agency (MPGA) 1 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 (mmlddlyyyy): 7/5/2020 Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) 0 Noncompliant — Notice of Noncompliance (See upgrade Requirements on page 3) ❑ 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 #4) — Failing to protect groundwater ❑ Operating permit/monitoring plan requirements (Compliance Component #5) — Noncompliant Property Information Parcel ID# or SecfTwpiRange: 0411723410011 Property address: 2400 Fox Street, Orono, MN Reason for inspection: Property Transfer Property owner: Julie Lindbloom Owner's phone: or Owner's representative: Jeffery Dewing Representative phone: 952-471-2279 Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 Brief system description: 2-1300 gallon septic tanks and 1-1300 gallon lift station and 620 square feet of mound rockbed. per city records Comments or recommendations: TBM: Top of the garage concrete slab. There is 1.0 Feet of sand 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. Inspector name: Joseph J Olson Business name: —Rusty OIs 's Soil & Perc. Testing Inspector signature: Necessary or Locally Required Attachments E Soil boring logs ❑ Other information (list): Certification number: 1255 License number: 810 Phone number: 763-498-8779 ® System/As-built drawing ❑ Forms per local ordinance www.pca.state.mn.us 651-246.6300 800-657.3864 TTY 651-282-5332 or 800-657-3864 . Available in alternative formats wq-wwists4.31 • 1124112 Page i of 3 Property address: 2400 Fox Street, Orono, MN Inspector initials/Date: J. O. 7/05/2020 1. Impact on Public Health —Compliance component #1 of 5 Compliance criteria: System discharge sewage to the ❑ Yes ❑ No round surface. System discharge sewage to drain tile ❑ Yes No or surface waters. System cause sewage backup into ❑ Yes ❑ No dwelling or establishment. Any "yes" answer above indicates the system is an Imminent Threat to Public Health and Safety. CommentslExplanation: 2. Tank Integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes ® No cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. Sewage tank(s) leak below their ❑ Yes ❑ No designed operatinNc depth. If yes, which sewage tank(s) leaks: Any "yes" answer above indicates the system is Failing to Protect Groundwater. CommentslExplanation: Albin's Septic Pumping LLC. pumped the tanks. Verification method(s): ® Searched for surface outlet ❑ Searched for seeping in yard/backup in home ❑ Excessive ponding in soil systemlD-boxes El Homeowner testimony (See CommentslExplanation) ❑ 'Black soil" above soil dispersal system System requires "emergency" pumping ❑ Performed dye test ❑ Unable to verify (See CommentslExplanation) ❑ Other methods not listed (See CommentslExplanation) 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 CommentslExplanation) ® Other methods not fisted (See CommentslExplanation) 3. Other Compliance Conditions —Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to structurally unsound. ❑ Yes' ®No ❑ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. ❑ Yes* ®No ❑ 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 ❑ Yes` Z No *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 • Available in alternative formats wq-wwists4-31 • 1124112 Page 2 of 3 Property address: 2400 Fox Street, Orono, MN 4. Soil Separation —Compliance component #4 of 5 Inspector initials/Date: J. O. 7/05/2020 Date of installation: 5127110 ❑ Unknown Verification method(s): ShorelandlwelIhead protectionlFood Beverage ® Yes ❑ No ,Soil observation does not expire. Previous soil Lodging? observations by two independent parties are sufficient, Compliance criteria:_ s unless site conditions have been altered or local For systems built prior to April 1, 1996, and [IYes ElNo requirements differ. not located in Shoreland or Wellhead ® Conducted soil observation(s) (Attach boring logs) Protection Area or not serving a food, ❑ Two previous verifications (Attach boring logs) beverage or lodging establishment: ❑ Not applicable (Holding tank(s), no drainfield) Drainfield has at least a two -foot vertical ❑ Unable to verify (See CommentslExplanation) separation distance from periodically ❑Other (See CommentslExplanation) saturated soil or bedrock. Non-performance 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.* "Experimental, "Other", or "Performance" 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. ® Yes ❑ No Comments/Explanation: ❑ Yes ❑ No Indicate depths of elevations Any "no" answer above indicates the system is Failing to Protect Groundwater. A. Bottom of distribution media 1 92.0 3.0 D. Required compliance separation` 2.6 *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? ❑ Yes ❑ No If "yes", A below is required Is the system required to employ a Nitrogen BMP? ❑ Yes ❑ No If "yes", B below is required BMP=Best Management Practice(s) specified in the system design !f the answer to both questions is "no", this section does not need to be completed. Compliance criteria a, Operating Permit number: Have the Ooeratina Permit reauirements been met? ❑ Yes ❑ No Any "no" answer indicates Noncompliance. 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. www.pca.state.mn.us 651-296-6300 800-657-3864 TTY 651-282-5332 or 800-657-3864 . Available in alternative formats wq-wwists4-31 • 1124112 Page 3 of 3 Minnesota Pollution Sewage Tank Maintenance Control Agency 520 Lafayette Road North Reporting Form St. Paul, MN 55155-4194 Subsurface Sewage Treatment Systems (SSTS) Program Purpose: Management and maintenance of Subsurface Sewage Treatment Systems (SSTS) are important to ensure resource protection and long-term and cost-effective sewage treatment. Completion of this form complies with the sewage tank maintenance requirements under Minn. R. 7080.2450 and 7082.0600. 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 and may only certify sewage tank compliance status when entirely completed and signed on page 3 by a qualified professional. Instructions: A copy of this information must be submitted to the system owner within 30 days of the maintenance date and be maintained by the licensed SSTS maintainer business for a period of five (5) years from the maintenance date. Maintenance reporting to the local unit of government may be required by local ordinance. Check with your local SSTS program for maintenance reporting protocol. Secure maintenance hole covers All maintenance hole covers must be returned to service in a sound and durable condition and be capable of withstanding the anticipated load. Covers must be re -secured in accordance with Minn. R. 7080.2450, subp. 3, items C or D: a) Covers installed under local ordinances adopted after February 4, 2008 must be locked, bolted or screwed or must be 95 pounds in weight. They must be made of material suitable for outdoor use, resistant to ultraviolet degradation and leaks, and not susceptible to being slid or flipped. They must have a label warning of hazardous conditions inside the tank. All screw openings must be refastened. b) Covers installed under local ordinances adopted before February 4, 2008 must either be buried with at least 12 inches of soil cover or be secured according to the local ordinance in effect before February 4, 2008. c) Covers must meet item 'a' above when raised to the ground surface or less than 12 inches from the ground surface. Reporting information Date of maintenance (mmiddlyyyy): 813012020 Reason for maintenance: Compliance Inspection Property address: 2400 Fox Street Parcel ID: 0411723410011 City: Orono Property owner's name: Julie Lindbioom Property -owner's address if different: City; _ Phone number: State: MN Zip code: 55391 State: Email address: Zip code: _ 1. Did you measure the accumulation of scum and sludge? ❑ Yes ® No (tank(s) pumped without measuring) Tank (check if present) Scum Sludge _ Operating depth Percent full ❑ Septiclholdinq tank #1 50 ® Septic/holding tank #2 p 20 El Pretreatment tank M Pump tank i j 1 1 5 2. Access used to remove septage: ® Maintenance hole ❑ Other (Unless a holding tank, go to #4 below) 3. If the maintenance hole was used, were all covers secured in place? Z Yes © No If no, please explain below: 4. If the 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 (Print owner's name) hole. I understand that removal of solids and liquids through other access points is not considered a compliant method of solids removal and does not fulfill the solids removal requirements of Minn. R. 7080.2450 and 7082.0600. Owner's signature: Date (mmlddlyyyy): _ .._ www.pca.state.mn.us 651-296-6300 + 800.657-3864 Use your preferred relay service Available in alternative formats wrr-ww15rs4-.1R . 1!77117 Pa¢e i of 3 Property address: City: _Orono _ 5 6. 2400 Fox Street Parcel ID State: MN Zip code Is the tank designed as a leaky tank? (Example: seepage pit, cesspool, drywell, leaching pit) Tank #1: ❑ Yes ❑ No Verification method used: VISUAL Tank #2: ❑ Yes 0 No Verification method used: VISUAL Is there evidence of the following? 0411723410011 55391 7. How many gallons of septage were removed? Tank #1: 1000 Tank #2: 1000 Pretreatment Tank: Pump Tank: 300 _ 8. Where was the septage taken? ® Wastewater treatment facility ❑ Land application ❑ Other Explanation (Facility name/Site #): Watertown 9. Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system? ❑ Yes ® No If yes, identify tank and explain: ❑ Evidence of non-domestic waste ❑ Baffie(s) condition ❑ Effluent screen condition ❑ Maintenance hole and extensions condition ❑ Other conditions (e.g. structural integrity of tank or lid, electrical hazard, etc.) Explanation: 10. List any troubleshooting and minor repairs completed or declined by owner: ❑ Troubleshooting and repairs conducted: I ❑ Repairs declined by owner: Additional comments or suggestions for owner's consideration: A filter is installed in the2nd tank and should be pulled and flushed twice a year Pumping record I personally conducted the work described above on behalf of a Minnesota -licensed SSTS Maintenance Business, in compliance with Minnesota Rules Chapters 7080 — 7083: ❑ As a noncertified individual who has received proper training, daily work review, and periodic observation, or ® As a designated certified individual of the business listed below. Company information Employee information Company name: Chip Septic Services — Print name: Pernel Hentges Business license number: 2064 Email Employee's signature: Certification number: (if applicable): Phone number: 952-200-3176 Date (mmlddlyyyy): 613012020 vrww.pca.state.mn.us • 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wn-wwkh;4- 3R . 1/27/17 Pa4e 2 of 3 Maintenance hole cover is Tank leaks below the Tank leaks above the damaged, cracked, unsecured, or __Tank (check if present) designed operating depth designed operating depth appears to be structurally unsound Septic/holding Tank #1 1 ❑ Yes E No ❑ Yes ®No ❑ Yes ® No ® Septic/holding Tank #2 i ❑ Yes ®No ❑ Yes 0 No ❑ Yes ® No ❑ Pretreatment Tank A ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Pump Tank _ _ [❑ Yes ® No ❑ Yes ® No ..... i .---[]Yes O No Describe detail for any "Yes" 7. How many gallons of septage were removed? Tank #1: 1000 Tank #2: 1000 Pretreatment Tank: Pump Tank: 300 _ 8. Where was the septage taken? ® Wastewater treatment facility ❑ Land application ❑ Other Explanation (Facility name/Site #): Watertown 9. Did you identify any operational issues or unsafe conditions while assessing the sewage tanks in this system? ❑ Yes ® No If yes, identify tank and explain: ❑ Evidence of non-domestic waste ❑ Baffie(s) condition ❑ Effluent screen condition ❑ Maintenance hole and extensions condition ❑ Other conditions (e.g. structural integrity of tank or lid, electrical hazard, etc.) Explanation: 10. List any troubleshooting and minor repairs completed or declined by owner: ❑ Troubleshooting and repairs conducted: I ❑ Repairs declined by owner: Additional comments or suggestions for owner's consideration: A filter is installed in the2nd tank and should be pulled and flushed twice a year Pumping record I personally conducted the work described above on behalf of a Minnesota -licensed SSTS Maintenance Business, in compliance with Minnesota Rules Chapters 7080 — 7083: ❑ As a noncertified individual who has received proper training, daily work review, and periodic observation, or ® As a designated certified individual of the business listed below. Company information Employee information Company name: Chip Septic Services — Print name: Pernel Hentges Business license number: 2064 Email Employee's signature: Certification number: (if applicable): Phone number: 952-200-3176 Date (mmlddlyyyy): 613012020 vrww.pca.state.mn.us • 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wn-wwkh;4- 3R . 1/27/17 Pa4e 2 of 3 Property address: 2400 Fox Street _ City: Orono State: MN Parcel ID: 0411723410011 Zip code: — 55391 _ 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 (1301) 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-wwists4-31b. This form can be found on the MPGA website at httos:l!www.Dca,state.mn.us/waterissts-and-msts-te_c_hnical-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. Z Certificate of sewage tank compliance Affirm all three statements: M 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: Chip Septic Services _ Business license number: 2064 ❑ Notice of sewage tank non-compliance Select all that apply: ❑ The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit. ❑ 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 cover(s) or other unsafe condition. Designated Certified Individual (DCI) information Print name: Perel Hentges__ Certification number: I personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS Maintenance Business. I personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS: Designated Certified Individual's signature: _ _ Date (mm/dd/yyyy): 06/3012020 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 Use your preferred relay service wa-wwists4-38 . 1127117 Available in alternative formats Pace 3 of 3 Soil Observation Log www.SeptieResource.com vers 12.4 Owner Information Property Owner / project: Julie Lindbloom Date 7/5/2020 (Property Address / PID: 2400 Fox Street Soil Survey Information ❑ refer to attached soil survey Parent mail's: 0 Till ❑ outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ summit ❑ Shoulder ❑ Side slope ❑ Toe slope soil survey map units: L41 U2 slope % direction- Lineal Soil Log #1 Q Boring ❑ Pit Elevation 91.0 Depth to SHWT 26 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-8 Topsoil <35 10yr3/1 Friable Moderate Blocky 8-14 Clay Loam <35 10yr4/3 Friable Moderate Blocky 14-26 Clay Loam <35 10yr5/4 Friable Strong Blocky 26-30 Clay Loam <35 10yr5/4 10y4/8,1 -6/10y Firm Strong Blocky < loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy X50 rigid strong massive Comments: ®is !4