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HomeMy WebLinkAbout08-17-2022 Septic ComplianceMINNESOTA POLLUTION Compliance inspection report form CONTROL AGENCY 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SETS) 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 https://www.pca.state.mn.us/sites/default/files/wa-wwists4-31a.pdf. Property information Local tracking number: Parcel ID# or Sec[Twp/Range: 2711823310012 Reason for Inspection Property Transfer Local regulatory authority info: City Of Orono, (952) 249-4600 Property address: 2140 Salem Court, Orono Owner/representative: Lynn Johnston Owner's phone: 612-655-0926 Brief system description: 3 -1000 -gallon septic tanks, 1 -1300 -gallon lift station and 630 Square feet Rock bed System status System status on date (mm/dd/yyyy): 8/17/2022 ® 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. 7080.9500 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 (ITPNS) 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 ❑ 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 1.5 feet of sand under the rock bed. Two rock beds 32 feet in length. 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. By typing my name below, l 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: C1255 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): https://www.pca.state.mn.us 651-296-6300 800-657-3864 • Use your preferred relay service Available in alternative formats wq-wwists4-31b • 4/28/1021 Poge 1 of 4 Property Address: 2140 Salem Court, 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* 10 No tile or surface waters. System causes sewage backup into ❑ Yes- ID 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: 8/1712022 Attached supporting documentation: ❑ Other: Z Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes` Z No cesspool, drywell, leaching pit, j J or other pit? Sewage tank(s) leak below their ❑ Yes* ®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. https://www.pca.state.mn.us 651-296-6300 800-657-3864 wq-wwists4-31b + 4128/2021 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 06/30/2022 (mmldd/yyyy): (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: Use your preferred relay service Available in alternative formats Page 2 of 4 Property Address: 2140 Salem Court, Orono Business Name: Rusty ©lson Soil 8 percolation Testing 3. Other compliance conditions — Compliance component #3 of 5 Date: 6/17/2022 3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? []Yes* Z No ❑ Unknown 3b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? ❑ Yes- M 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* ENO 3d, System not abandoned in accordance with Minn. R. 7080.2500? ❑ 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. Jf Not applicable ❑ 4. Operating permit and nitrogen BMP* —Compliance component #4 of 5 O 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) ❑ https://www,pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 4128/2021 Page 3 of 4 Properly Address: 2140 Salem Court, Orono Business Name: Rusty Olson Soil & percolation Testing S. Soil separation — Compliance component #5 of 5 Date of installation 9/9/2015 ❑ Unknown (mmlddlyyyy) ShorelandlWellhead protection/Food 0 Yes ® No beverage lodging? Compliance criteria (select one): 5a. For 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 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: 811712022 Attached supporting documentation: El 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 110.4 - 109.4 B. C. soil/bedrock 1 107.4 -106.4 *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. https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 412812021 Page 4 of 4 Tank Report Date: June 30. 2022 Elmer .l. Peterson Co. if) Z 1 Dague .Ave. Delano, ININ 55.428 Phone 761-972-2420 I•'ax 763-972-7217, \11'CA License# 1111 Lvnn Johnston 2140 Salem Court Orono. MN 612-655-0926 Raffles: DON/ OF Tank Capacity: _ 3-1000 Gallon Tanks and 1-1300 Gallon Pump Tank # of'f'anks: 4 Type of `Dank,: _ [gallons Pumped: Concrete 4500 Manholes to Gracie: YES / NO Comments:. Cin June 30, 2022. Elmer J. Peterson Co. pumped tanks. Pump tank manhole is buried 8 inches and all other manholes to grade. First three tanks are 2 piece tanks. No water leaking in tanks at the time of pumping. NO'm "Phis is only a tank report. This is not a compliance inspection f6r point of'sale nor cfix s it replace a Compliance inspection. 1 MINNESOTA POLLUTION Sewage tank integrity assessment farm CONTROL AGENCY 524 t-afayette Road North Subsurface Sewage St. Paul, MN 55155-4144 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 fon►'/ 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 llwww pca state mn us/wateritnspe-ior?s, Instructions: This form may be completed, and signed, by a Designated Certified Individual (DCII 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: QpjDpharice insoectian foie• Existing system (wq-wwists4-310 This form can be found on the MPGA website at httiDr 1'wvrw oca state mn ushvaterlinsoectio,rr_ 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 Inspecior 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(6)(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(Cl Owner information Owner/Representative Lynn Johnston Property address 2140 Salem Court Orono, MN Local Regulatory Authority, Parcel ID System status System status on date (mmiddiyyyy) 6/30/2022 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 Ll Yes` 0 No Groundwater." The SSTS has a sewage tank that leaks below the designed operating depth - 'Failure to Protect [] Yes- 0 No 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 ❑ Yes- iD No Public Health or Safety." Any "yes answer above indicates sewage tank non-compliance. Company information Company name Elme r J. Peterson Co Business license number 219 Designated Certified Individual (DCI) information Print name: James L Braegelmann Certification number I personally conducted the work described above as a Designated Certifier/ 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 typingfsigning my name below t certify the above statements to be true acid correct. to the hest of nay knowledge. and that this infonnation cat) be used for the purpose of processing this form Designated Certified lndividuafs signature: James L Braegelmann Date (mml'ddiyyyy) 6130/2022 (This document has been electronically segned ) www.pca.state.mn.us b5i 296-6300 800-557-39(A use your preferred relay service Available in alternative formats wQ-wwi5ts4 91 • 511012I Poge 1 of 1 Property Owner 1 project:. Property Address 1 PID: Soil Observation Log www.SepticResource.com vers 12.4 Owner Information Lynn Johnston 2140 Salem Court Date 8/14/2022 Soil Surve Information ❑ refer to attached soil survey Parent matl's: D Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ Summit ❑ Shoulder El Side slope ❑ Toe slope soil survey map units: L3713 slope % direction - Soil Log #1 D Boring ❑ Pit Elevation 105.1 Depth to SHWT 18 Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-18 Loam <35 10yr3ll Friable Strong Blocky <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky Cum moderate prismatic platy >50 rigid strong massive Comments: TBM: Top of basement concrete slab ELV.-95.0 2140 Salem Court Sol Log #2 Q Boring n pit Elevation 108.1 Depth to SHWT 18 Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-4 Loam <35 10yr3/l Friable Strong 1310cky 4-12 Clay Loam <35 10yr4/3 Friable Strong etocky 12-18 Clay Loam <35 10yr5/4 Friable Strong Blocky <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid I strong I massive 2140 Salem Court Soil Log #3 ❑ Boring ❑ pit Elevation Depth to SHWT Depth (in) Texture fragment % matrix color redox color consistence grade shape <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive 1 hereby certify this work was completed in accordance with AM 7080 and any local reqs. Rusty Olson"s Soil & Pere 810 igner Signature Company License # r IKS WAR