HomeMy WebLinkAbout09-23-2020 Septic Compliance InspectionPage 1 of 3
Certificate of Compliance
Inspection Form
New Subsurface Sewage
Treatment Systems (SSTS)
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
Parcel ID# or Sec/Twp/Range:
Reason for inspection:
Owner’s phone:
Representative phone:
Regulatory authority phone:
Property Information
Property address: 730 Gander Road
Property owner:
or
Owner’s representative: Metro General Services Inc.
Local regulatory authority: City of Orono
Brief system description: Comments orrecommendations:
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.
Certification number:
License number:
Phone number:
Inspector name:
Business name:
Inspector signature:
Necessary or Locally Required Attachments
Soil boring logs System/As-built drawing
Other information (list):
Compliant – Certificate of Compliance
Valid for 5 years from report date
Reason(s) for noncompliance (check all applicable)
X
New instalation
(763)428-2938
952-249-4600
Roger Peitso C6683
952-249-4625
X X
Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements
and attached forms System status on date 9/23/2020
Page 2 of 3
Property address: Inspector initials/Date:
(mm/dd/yyyy)
1.Impact on Public Health – Compliance component #1 of 5
Compliance criteria: Verification method(s):
System discharges sewage to the
ground surface.
Yes No Searched for surface outlet
Searched for seeping in yard/backup in home
Excessive ponding in soil system/D-boxes
Homeowner testimony (See Comments/Explanation)
“Black soil” above soil dispersal system
System requires “emergency” pumping
Performed dye test
Unable to verify (See Comments/Explanation)
Other methods not listed (See Comments/Explanation)
System discharges sewage to drain
tile or surface waters.
Yes No
System causes sewage backup into
dwelling or establishment.
Yes No
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
Compliance criteria: Verification method(s):
System consists of a seepage pit,
cesspool, drywell, or leaching pit.
Seepage pits meeting 7080.2550 may be
compliant if allowed in local ordinance.
Yes No 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 Comments/Explanation)
Other methods not listed (See Comments/Explanation)
Sewage tank(s) leak below their
designed operating depth.
Yes No
If yes, which sewage tank(s) leaks:
Any “yes” answer above indicates the
system is failing to protect groundwater.
Comments/Explanation:
3.Other Compliance Conditions – Compliance component #3 of 5
a.Maintenance hole covers are damaged, cracked, unsecured, or appear to be 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* No
*System is failing to protect groundwater.
Explain:
X
X
X
X
V
Inspected installation of new tanks
X
X
X
730 Gander Road RLP 09/23/2020
New installation
Page 3 of 3
Property address: Inspector initials/Date: |
(mm/dd/yyyy)
4.Soil Separation – Compliance component #4 of 5
Date of installation: Unknown Verification method(s):
Soil observation does not expire. Previous soil
observations by two independent parties are sufficient,
unless site conditions have been altered or local
requirements differ.
Conducted soil observation(s) (Attach boring logs)
Two previous verifications (Attach boring logs)
Not applicable (Holding tank(s), no drainfield)
Unable to verify (See Comments/Explanation)
Other (See Comments/Explanation)
(mm/dd/yyyy)
Shoreland/Wellhead protection/Food beverage
lodging? Yes No
Compliance criteria:
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.
Yes No
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.*
Yes No
“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
A.Bottom of distribution media
B.Periodically saturated soil/bedrock
C.System separation
D.Required compliance separation*
Any “no” answer above indicates the system is
failing to protect groundwater.
5.Operating Permit and Nitrogen BMP* – Compliance component #5 of 5 Not applicable
Yes No If “yes”, A below is required
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
Yes No Have the Operating Permit requirements been met?
b.Is the required nitrogen BMP in place and properly functioning? 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. If the system is failing to protect ground water, the system must be upgraded, replaced,
or its use discontinued within three years of receipt of this notice. 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. 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.
730 Gander Road 09/23/2020
09/23/2020
X
101.3
98.1
3.2
X
Comments/Explanation:
Benchmark 100' at Grade of soil boring # 1 top corner of mound
Indicate depths or elevations
Is the system operated under an Operating Permit?
Is the system required to employ a Nitrogen BMP?
a.Operating Permit number:
3
RLP
X
Address:
Installer:
X I II X
1
2
3
4
5
6
7
8
9
10
11
12
2-1250 1-1250 Date Finaled:9/23/2020
Metro General Services Inc
Building Use:
Bedrooms #Pump Tank:
Other
License #L1546
City of Orono Septic Asbuilt Form
SFD
A B
Septic Tanks:
System Type:Mound Pressure Bed
Draw detailed diagram with measurements indicating distances to tank Risers. Use two(2) points from a permanent
structure. Show locations of drop Boxes and length of trenches
9/22/2020
TrenchesIII
Date:
5
730 Gander Road
48'
60'
75'
87'
51
63'
78'
90'