HomeMy WebLinkAbout02/24/2022 Compliance Inspection ReportMINNESOTA POLLUTION
CONTROL AGENCY Comp N Compliance inspection report form
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 htt s://www. ca.state.mn.us/sites/default/files/w -wwists4-31a. df.
Property information Local tracking number:
Parcel ID# or SecfTwp/Range: 0611723240014 Reason for Inspection Property Transfer
Local regulatory authority info: City Of Orono, 952 249-4600
Property address: 350 North Arm Lane, Orono
Own erlrepresentative: Barry Larson_
Brief system description: 1 -1300 -gallon, 1 -1000 -gallon septic tanks,
System status
System status on date (mm/dd/yyyy): 2/24/2022
® 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.
Owner's phone: 612-512-5037
1 -1300 -gallon lift station and 630 Square feet Rock bed
❑ 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
El 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 five bedroom house.
There is 1.3 feet of sand under the rock bed.
Certification
1 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
Inspector signature: Joseph J. Olson _
(This document has been electronically signed)
Certification number: 01255
License number: L810
Necessary or locally required supporting documentation (must be attached)
Phone: 763-498-8779
Soil observation logs ® System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit
❑ Other information (list):
https://www.pca,state.m:n.us 651-206-6300
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Page 1 of 4
Property Address: 350 North Arm Lane, Orono
Business Name: Rusty Olson Soil & percolation Testing
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' 0 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: 2/2412022
Attached supporting documentation:
❑ Other:
® Not applicable
2. Tank integrity — Compliance component #2 of 5
Compliance criteria:
System consists of a seepage pit, ❑ Yes* ®No
cesspool, drywell, leaching pit,
or other pit?
Sewage tank(s) leak below their ❑ Yes' Z 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 02/15/2022
(mm/ddlyyyy): (must be within three years)
(See form instructions to ensure assessment complies with
Minn. R. 7082.0700 subp. 4 B (1))
❑ Tank is Noncompliant (pumping not necessary - explain below)
❑ Other:
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Property Address: 350 North Arm Lane, Orono
Business Name: Rusty Olson Soil $ percolation Testing Date: 2/24/2022
3. Other compliance conditions — Compliance component #3 of 5
3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured?
❑ Yes" ER 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* 0 No
3d. System not abandoned in accordance with Minn. R. 70$0.2500? ❑ 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: N 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) ❑
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Property Address: 350 North Arm Lane, Orono
Business Name: Rusty Olson Soil & percolation Testing
5. Soil separation -- Compliance component #5 of 5
Date of installation 12/15/1993 _ ❑ Unknown
(mmfdd/yyyy)
ShorelandfWell head protection/Food ® Yes ❑ No
beverage lodging?
Compliance criteria select
5a. Far 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:
Date: 2/24/2022
Attached supporting documentation:
® Soil observation logs completed for the report
❑ Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
Indicate depths or elevations
A. Bottom of distribution media 100.0
B. Periodically saturated soil/bedrock 97.2
C. System separation 2.8 _
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.
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Page 4 of 4
Tank Report
Date: February 15, 2022
Elmer J. Peterson Co.
5921 Dague Ave.
Delano, MN 55328
Phone 765-972-224
Fax 763-972-7217
MPCA License# 219
Barry or Faith Larson
350 N. Arm Lane
Orono, MN
612-512-5037 Faith
Baffles: 8 /
Tank Capacity:
OFF
3-1300 Gallon Septic Tanks
# of Tanks: 3
Type of Tanks: Concrete
Gallons Pumped:
3000
Manholes to Grade: YES / NO
Continents:
On February 15, 2022, Elmer J. Peterson Co. uncovered 15I manhole 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.
1 MINNESOTA POLLUTION Sews a tank integrity assessment form
CONTROL AGENCY g
520 Lafayette Road North Subsurface Sewage
St. Paul, N1N 55155-4194 Treatment Systems (SSTS) 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:
htt s://www. ca.state.mn.us/waterline ections.
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 (wo-wwists4-31 0. This form can be found on
the MPCA website at htlps:l/www.pea. state. mn.uslwaterlinsnectionS.
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(8),(C),
and (D) and; Minn. R. 7083.0730(0).
Owner information
Owner/Representative Barry or Faith Larson _
Property address: 350 N. Arm Lane, Orono, MN
Local Regulatory Authority: Parcel ID:
System status
System status on date (mmldd/yyyy): 2/15/2022
E Certificate cif 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` No
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect
Groundwater." ❑ Yes'° No
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 ❑ Yes" No
Public Health or Safety."
Any "yes" answer above indicates sewage tank non-compliance.
Company information Designated Certified Individual (DCI) information
Company name: Elmer J. Peterson Co Print name: James L Brae elmann _
Business license number: 219 Certification number:
1 personalty 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, 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.
Designated Certified Individual's signature: James L Braegelmann Date (mm/dd/yyyy): 2115/2022
(This document Inas been electronically signed.)
uvww.pcastate.mn.us �. ----
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Soil Observation Log
N1ct1.��nEicResnurcc:.rnm r�>re 17
Owner Information
Propert} Owner project: Douglas Olson Date 2/8/2018
PropenN Address PID; 350 North Arm Lane;
Soil Survey Information ❑ refer to attached sail survey
Parent mall's: �; Till ❑ Outwash ❑ Lacustrine ❑ Xluvium ❑ OrganicC: Bedrock
landscape position: D summit ❑ Shoulder F Side slope ❑ Toe slope
soil survey snap units: L41 C2 slope % direction- Lineal
Soil Log #1
❑r Boring ❑ Pit Elevation 100.5 Depth to SHVwT 38 inches
]Depth (in) Texture fragment ° o matrix color redox color consistence grade shape
loose
loose
single gain
0-20
Fill
35
friable
weak
granular bloc k
_
finn
moderate
Prismatic platy
rigid
strong
massive
20-28
Topsoil
35
10yr3/1
Loose
Loose
sim_lc _r,iin
?8-12
clan Loam
<35
1Oyr4,3
Friable
Strong
Bl,d,\
32-38
Clay Loam
3
IOyr5: 1
Friable
Strang
[3litcky
3£_40
Cl t\ Luam
10)x5`:}
IOy4.%8.1-6/1Oy
FirmStrt�n<<
t31,, 1,\
Cnmments:
-M North Arm Dane Soil Log #2
❑ Boring ❑ Pit Elevation 100.5 Depth to SEIWT 40 inches
Depth (in) Texture fi-agment °o Inatrix color redox color consistence grade shape;
loose
loose
single grain
U 33
Fill
<,35
friable
weak
granular blocky
firin
moderate
prismatic Plate
rigid
strong
massive
22-36
Topsoil
35
Loose
Loose
single grain
,6-40
Clay Loam
<35
1Oyr4.'3
triable
Strong
131uck+
40-54
Clay Loam
35
2.5'0 1
lOy418,1-6/10y
titin
Strong
Blocky
X35
loose
loose
single grain
35-50
friable
weak
granular blocky
-
>5(1
firm
tnoderate
Prismatic plat)-
rigid
strong
massive
50 North Arm Lane Soil Log #3
Q Boring ❑ Pit Elevation depth to SHWT
Depth (in) "Texture fragment ° o inatrix color redox calor consistence grade shape
<j5
loose
loose
single grain
35-50
friable
weak
granular block%
>50
firm
moderate
prismatic plat%
rigid
strong
Iiiassive
,35
loose
loose
single grain
35-50 S0
friable
weak
granular blocky
-
>-
firrn
moderate
prismatic platy
ri-id
strong
massive
<35
loose
loose
single grain
35-50
.�
friable
weak
gramdar blocky
%$0
firm
moderate
prismatic platy
rigidstrong
massive
X35
loose
loose
single grain
35-50
triable
weak
granular hlockN
>50
firn
inoderate
prismatic Flat%
rigid
Strong
Massie c
<35
loose
loose
single grain
35-50
friable
weak
granular blockN
>50
firm
moderate
Prismatic Plat.
rigid
strong
massive
I herch-v c•ert4j- this 11.01* IL'US COMM lcletl in ac•c•nrclarue with MN 7080 and a►tt' local r•ey's.
Designer Signature
Rusty Olson's Soil & Perc 810
Company License #
Soil Observation Log
www.Ser)tieResource.com vers 12.4
Owner Information
Property Owner / project: Barry Larson Date 2/16/2022
Property Address / PID: 350 North Arm Lane
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: 1] Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit U Shoulder 0 Side slope ❑ Toe slope
soil survey map units: L41C:2 slope % direction- Lineal
Soil Log #3
Q Boring ❑ pit Elevation 99.0 Depth to SHWT 18 Inches
Depth {in} Texture fragment % matrix color redox color consistence grade shape
0-14
Loam
<35
10yr3/1
Friable
Strong
Blocky
14-18
Clay Loam
<35
IOyr4/3
Friable
Strong
Blocky
18-24
Clay Loam
3
IOyr5/4
I Oy4/8,1-6/1 Oy
Firm
Strong
Hluckti
<35
loose
loose
single grain
35-50
friable
weak
granular blocky
>50
firm
moderate
prismatic platy
rigid
strong
massive
�'S
loose
loose
single grain
35-50
friable
weak
granular blocky
>50
firm
moderate
prismatic platy
rigid
strong
massive
Comments: TBM: Bottom of the rock bed. ELV.-100.0
IN
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