Loading...
HomeMy WebLinkAbout10-02-22 Septic Compliance InspectionMINNESOTA POLLUTION re Compliance inspection ort form CONTROL AGENCY p p p 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) 5t. 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 httK)s://www. Rca.state.mn.us/sites/default/fileslw-wwists4-31 a. gdf. Property information Local tracking number: Parcel 1D# or SecfTwp/Range: 3211823340004 Reason for Inspection Permit Local regulatory authority info: City of Orono Property address: 65 Stubbs Bay Road Owner/representative: Alma Homes L.L.C. Owner's phone: 612-741-9069 _ Brief system description: Existing system Approximately 2 -1000 -gallon septic tanks, 1 -1000 -gallon lift station and 380 square feet of mound rock bed. System status System status on date (mm/dd/yyyy): 10/2/2022 ® 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 (1TPHS) 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 42) — 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 There is 1.0 feet of sand under the the rock bed. TBM: Invert of the Calvert. ELV.-986.6 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, 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 8, 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): https://www.pca.state.mn,us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 1 of 4 Property Address: 65 Stubbs Bay Road 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` ® No tile or surface waters. System causes sewage backup into ❑ Yes" ® No Any "yes" answer above indicates the system is an imminent threat to public health and safe Describe verification methods and results: Visual. Nothing was found Date: 10/2/2022 Attached supporting documentation: ❑ Other: ® 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? Yes' M No ❑ Yes' ® No _If yes, which sewage tanks) leaks: � Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Duanes Septic Service 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 9_126/2022 (mmidd/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: https://www.pca.state.mn.us 651-296-6300 800-657-3864 • Use your preferred relay service Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 2 of 4 Property Address: 65 Stubbs Bay Road Business Name: Rusty Olson Soil & percolation Testing Date: 10/2!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* ® 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* ® No 3d. System not abandoned in accordance with Minn. R. 7080.2500? *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 ❑ ❑ Yes' ® No 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) ❑ 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 3 of 4 Property Address: 65 Stubbs Bay Road Business Name: Rusty Olson Soil & percolation Testing 5. Soil separation — Compliance component #5 of 5 Date of installation 8/27/1996 ❑ Unknown (mmldd/yyyy) 5horelandlWellhead protection/Food ❑ Yes ® No beverage lodging? Compliance criteria (select one): 5a. For systems built prior to April 1, 1996, and ❑ Yes ❑ No - not located in Shoraland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: j 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.* Date: 10/2/2022 Attached supporting documentation: ❑ Soil observation logs completed for the report ❑ Two previous verifications of required vertical separation ❑ Not applicable (No soil treatment area) ® Yes ❑ No* Indicate deaths or elevations 5c. "Experimental', "Other", or "Performance" ❑ Yes ❑ No* systems built under pre -2008 Rules; Type lV 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: A. Bottom of distribution media 981.9 B. Periodically saturated soil/bedrock 979.1 C. System separation 2.$ 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 (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. 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 • 4/28/2021 Page 4 of 4 CONROLMINNESOTA N�CY ON Sewage tank integrity assessment form 520 Lafayette Road North Subsurface Sewage St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program Property address: %j Parcel 0 City State: _M �V. - Zip code: _ !�,C✓ 3 S ci I 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. SETS compliance inspection report forms can be found at: illttas.11wwvd�aca_state r!n.usl�vairlirrctiot�s. 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. 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: Comp ianca__torrr, w x._ t;=__et;q-vs +silts 31. This form can be found on l the M P C A website at h"�stais.mn, sltirirt�rlrns ctio , ! The information and certified statement on this form is required when existing septic tank compliance status is determined by an l individual other than the SSTS Inspector that submits an inspection report This form represents a third party assessment of SETS 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. l [Certificate of sewage tank compliance ❑ Notice of sewage tank non-compliance Affirm a I three statements: Select all that apply: The SETS does not contain a seepage pit, cesspool, ❑ The SSTS has a seepage pit, cesspool, drywell, drywell, leaching pit, or other pit. leaching pit, or other pit —"f=ailure to Protect [t __does not contain a sewage tank that was designed Groundwater." to be watertight, but subsequently leaks below the ❑ It has a sewage tank that was designed to be d ned operating depth, watertight, but subsequently leaks below the designed It does not represent an imminent safety threat by operating depth —"f=ailure to Protect Groundwater." reason of unsecured, damaged, or weak ❑ It presents a threat to public safety by reason of maintenance hole cover(s) or other unsafe condition. unsecured, damaged, or weak maintenance hole cover(s) or other unsafe condition -- w"Imminent Threat to Public Health or Safety." Company information Company name: _Duane's Septic Service Designated Certified Individual (DCI) information Print name: 1) 41 "1- ,V e _ ]'AZ Business license number: 654 _ _ Certification number cz.0 b'Lf I personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection, maintenance, installation, orservice 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 n Individual's signature: /��� Date (mmlddlyyyy): �— L [- Z 2 (This dacument has been electron�Iyned. j www.pca.state.mn,us 651-296-6340 800-557-3664 Use your preferred relay service Available in alternative formats wq-wwi5t54-91 • 115121 Page 1 of 1 5873 Robert Road Soil Log #4 Boring ❑ pit Elevation 9789 Depth to SHWT 12 Inches Depth (in) Texhlre fragment % matrix color redox color consistence grade shape 0-22 Loam <35 10yr2/1 Friable Strong Blocky 22-30 Clay Loam <35 10yr2/2 10y4/8 Friable Strong Blocky <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 7S0 firm moderate prismatic platy ri id strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive 5873 Robert Road Soil Log #5 D Boring ❑ pit Elevation 980.6 Depth to SHWT 26 Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-26 Loam <35 10yr2/1 Friable Strong Block} <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 >50 firm moderate prismatic platy rigid strop 2 massive <35 loose loose grain 35-50 friable weak granular blocky granular >50 firm moderate prismatic platy rigid stronR massive <35 loose loose single grain 35-5a friable weak granular blocky >50 firm moderate prismatic platy ri id strong massive 1 hereby certify this work was completed in accordance with MN 7080 and any local reqs. Rusty OlsoWs Soil & Pere 810 D tgner Signature Company License ## Soil Observation Log www.SepticResource.com vers 12.4 Owner Information Property Owner/ project: Gerrett Gronberg Date 5/7/2022 Property Address / FID: 5873 Robert Road Soil Survey Information ❑ refer to attached soil survey Parent matl's: 21 Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ Summit ❑ Shoulder 1] Side slope ❑ Toe slope soil survey map units: 132A slope b % direction- Linear Soil Log 46 0 Boring ❑ pit Elevation 981.6 Depth to SHWT 34 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-12 Mound fill <35 12-34 Loam <35 10yi2i 1 Friable Strong Block} 34-40 Clay Loam <35 10yr2/2 I Oy4/8 Friable Strong Blocky <35 loose loose single grain 35-54 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive Comments: rs i \ / a 1 / 41 IA meq 2.rra� it L ' o � � r r� i --996— v f \ — X9888--31X \�— i o, O O rrl m v iua ~l 0 / 4 - ..... m Km y J rr 7.. /b _ o • ,� W 4.\ r ACKTOP~---^-•° _---- S T U B B S_B A Y ROA6WAY\ _ rr------ ROAD -SOUTH