HomeMy WebLinkAbout03/03/22 Septic ComplianceMINNESOTA POLLUTION Compliance inspection report form
CONTROL AGENCY p
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 hftps://www.pca.state.mn.us/sites/defaulilfiles/wa-wwists4-31a pdf.
Property information Local trackino number:
Parcel. ID# or Sec/Twp/Range: 2811823410002 Reason for Inspection Propery Transfer
Local regulatory authority info: City of Orono
Property address: 1125 Willow Drive N.
Owner/representative: William Leskinen Owner's phone: 612-845-8952
Brief system description: Approximately 2 -1000 -gallon septic tanks and a filter in tank 2, 1 -1000 -gallon lift station and 500 square feet
of mound rock bed.
System status
System status on date (mm/dd/yyyy): 3/3/2022
® 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 6 is discovered or
a shorter time frame exists in Local Ordinance.)
*Note: Compliance indicates conformance with Minn.
R. 7080.9500 as of system status date above and does not
guarantee future performance.
❑ 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
❑ Other Compliance Conditions (Compliance component #3) — Imminent threat to public health and safety
El 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
El Soil separation (Compliance component #5) — Failing to protect groundwater
❑ Operating permit/monitoring plan requirements (Compliance component #4) — Noncompliant - local ordinance applies
Comments or recommendations
There is 1.1 feet of sand under the rock bed.
TBM: Top of the lift station manhole cover. ELV.-100.0
The soils were verified by the City on 08/25/2011
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, 1 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 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)
❑ Soil observation logs ® System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit
❑ Other information (list): Soils verification
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Property Address: _1125 Willow Drive N. _
Business Name: Rus Olson Soil &percolation Testing
1. Impact on public health — Compliance component #1 of 5
Compliance criteria;
System discharges sewage to the ❑ Yes" ENO
ground surface
System discharges sewage to drain ❑ Yes` M 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: 3/3/2022
Attached supporting documentation:
❑ Other:
0 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?
Sewage tank(s) leak below their
designed operating depth?
If yes, which sewage tank(s) leaks:
[--]Yes* ED No
❑ Yes' 0 No
Any "yes" answer above indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Elmer J. Petersom 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 3/1/2022
(mm/dd/yyyy): (must be within three years)
(See fora 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: 1125 Willow Drive N.
Business Name: _ Rust V Olson Soil & percolation Testing
3. Other compliance conditions — Compliance component #3 of 5
Date: 3/3/2022
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* S 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. 70802500? ❑ 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: ® 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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Page 3 of 4
Property Address: 1125 Willow Drive N.
Business Name: Rusty Olson Sail &�-ercolation Testing
S. Soil separation — Compliance component #5 of 5
Date of installation 9/15/2011
1 a rrroiucLyyyy)
ShorelandlWelIhead protection/Food
beverage lodging?
Compliance criteria select one
5a. 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.
5b. 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.*
5c. "Experimental, "Other", or `Performance"
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.
❑ Unknown
Yes Z No
❑ Yes ❑ No*
❑ Yes ❑ No*
*Any "no" answer above indicates the system is
failing to protect groundwater.
Describe verification methods and results:
Date: 3/3/2022
Attached supporting documentation:
❑ Soil observation logs completed for the report
❑ Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
® Soils verified by the
Indicate depths or elevations
A. Bottom of distribution media
100.4
B. Periodically saturated soil/bedrock
97.4
C. System separation
3.0
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 (ITFHS) 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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Tank Report
Elmer I Peterson Co.
5921 Dague Ave.
Delano, MN 55328
Phone 768-972-2.+20
Fax 763-972-721.7
MPCA License# 219
Bill or Denise Leskinen
1125 Willow Drive N
Orono, MN
612-8458952
Baffles:N . /
Tank Capacity:
# of Tanks: 3
Type of Tanks:
Gallons Pumped:
OFF
3-1000 Gallon Tanks
Concrete
2500
Manholes to Grade: ES NO
Comments:
Date: March 1, 2022
On March 1, 2022, Elmer I Peterson Co. 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.
AMINNESOTA PO.iurloN
CONTROL AGENCY Sewage tank integrity assessment form
520 Lafayette Road North Subsurface Sewage
St. Paul, MN 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:
https://www.i)ca.state mn.us/water/inspections.
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 ins ection form - Existing system (M-wwists4-31 b). This form can be found on
the MPCA website at htt s:/lwww. ca.state.mn.uslwaterlins ections.
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(13)(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 Bill or Denise Leskinen
Property address: 112:5 Willow Drive N, Orono, MN
Local Regulatory Authority:
System status
Parcel ID:
System status on date (rnm/dd/yyyy): 3/1/2022
❑ 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."
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect
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." j
Any (eyes" answer above indicates sewage fame non-com.pliancc--.
Company information
Company name: Elmer J. Peterson Co
Business license number: 219
[-]Yes;' 0 No
❑ Yes" ® No
❑ Yes ® No
Designated Certified Individual (DCI) information
Print name: -James L Braegelmann
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. 1 personally conducted the necessary procedures to assess the compliance
status of each sewage tank in this SSTS.
By typing/signing my name below, 1 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: ,lames L Brae elmann Date (mm/dd/yyyy):_3/ I /2022
(This document has been electronically signod.)
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE $ SCHEDULED �I Civ
PERMIT NO.COMPLETED
ADDRESS f �'j , f ( CD L_1 , Li 19 -
OWNER TELEPHONE NO. _
CONTRACTOR 1 J 4 d 15011
L, INSPECTION REQUIRED. CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on
Inspector: L.6Z (f` -r { _� 4X—S. •
White Copyllnspector's File Canary Copy/Site Notice
5 a (S U C7� l C'�.4io/'J
DESCRIPTION "
I,
❑ FOOTING ❑ PLUMBING FINAL
❑ EXCAV/GRADING/FILLING
Q
❑ POURED WALL ❑ MECHANICAL RI
❑ LAKESHORE/WETLANDS
y
❑ FRAMING ❑ MECHANICAL FINAL
TREE REMOVAL
INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
�] RADON SLAB ❑ WATER HOOK-UP
❑ PROGRESS
D FINAL ❑ SEWER HOOK-UP
❑ COMPLAINT
11 DEMO - SITE ❑ SEPTIC MAINT.
❑ FOLLOW-UP
3
❑ DEMO - FINAL ❑ SEPTIC INSTALL
❑ HARD COVER REMOVAL
❑ PLUMBING RI ❑ SEPTIC FINAL
❑ FOUNDATION/REMOVAL
OWNERICONTRACTOR TO MEET YOU: _ YES _ NO
COMMENTS:
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❑ CORRECT WORK & PROCEED
^ ISSUE CERTIFICATE OF OCCUPANCY
O
G CORRECT WORK, CALL FOR REINSPECTION
TEMPORARY
BEFORE COVERING
PERMANENT
❑ CORRECT UNSAFE CONDITION WITHIN HOURS.
; F pFiOTd TAKEN
INSPECTOR WILL RETURN
F", STOP ORDER POSTED. CALL INSPECTOR
CITATION ISSUED
L, INSPECTION REQUIRED. CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on
Inspector: L.6Z (f` -r { _� 4X—S. •
White Copyllnspector's File Canary Copy/Site Notice
SEPTIC SYSTEM INVENTORY
Site Address: 1125 Willow Dr N PID 28-118-2341-0002
Owner Name: William & Denise Leskinen
Owner Address: 1126 Willow Dr N Long Lake MN 55356
BuildingTvpe: residence Installer: Hayes and sons
Date of hermit: 09/1512011
Svstem Tvme: mound BR's Designed for 4
In Musa?: No Shoreland?: no
SEPTIC TANKS:
Material: precast concrete Capacity: 1000, 1000, 1000 Tank Filter: yes
DRAINFIELD:
Treatment Area: 500 Soil Boring: yes DF Ht above Wt: 3
WELL DATA
Setbacks -Well Tanks: 50 Well DF: 50 Report In File: Depth:
Date I Notes
9/15/2011 New mound system installation
11/1/2006.Non-compliant, replace by 12/31/2010
11/3/2004 Non-compliant, replace by 12/31/2010
10/28/2002 non-compliant,replace by 12/31/2010
8/28/2000non-compliant, repair by 12/31/2010, pump
5/15/1998;non-compliant repair by 12/31/2008
10/26/1995.no surfacing -pump tanks
11/10/1993 DF compacted -pump tanks
10/22/1991,no surfacing -pump tanks
9/21/1989 no surfacing
8/12/19881no surfacing
8/27/1986 no surfacing
8/11/1981;no surfacing -owner replaced pump twice
12/22/1978 replacement installation
12/22/1978 replacement installation
PUMPOUT RECORDS
Date i GallonsOfLiquid
7/31/2017 2100
9/15/2011 0
10/15/2008 2000
11/30/2004 2000
5/28/2003 2000
10/31/2000 1000
10/31/2000 1000
0,
V4
12 12 09:30p
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Brad
7636820977
WORKSHEET FOR SEWAGE DISPOSAL WORK
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;1 `e Building Permit Na.
a2 ip-Shi
p.a
Property Address
Kind of Building__ _
SETS Installer_��-
Septc Tanks
Matariai0)�Lvu-j Number of Tanks
Drain Held: f
Total length of tines _ f --- -- -- Number of lines 3 _
Type of soil �c- C� Percelr�tion Test LY I S
Wfdthof'tnanch Type offikrmaterw 6 -cc �`-.b
Size of Mock Bell LQ -.P9 , % _.. Size of Absorption
Dmw detailed diagram wfth memummenft indicating distances to sapfic tank mars frwn a
pamtanei d S tcwM.
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