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� ��,;p�r����� � Street Address: Mailing Address:
,9kEg$��' 2150 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay; MN 55323-0066
Owner: ��.C'a1� �/�/q�5�, Address:_. I�O [3��q Z.S(q��
Cit�•Ordinance 199 requires that each existing on-site se�vage treatment system in Orono be inspected every two years.
The on-site seivage treatment system at the above address has been inspected and appears to fall into the categories checked below.'
SYSTEM CONFORMITY (1-3): 3
1 ��CODE SYSTEM° An ISTS which meets all the location,design and construction standards ofthe current Orono bfunicipal Code.
2 "COI�IPLIANT SYSTEM" An ISTS which does not meet all the location,dzsigi and construction standards ofthe current Orono Municipal
Code but does meet the three foot sepazation requirement,and which is not failing or an imminent threat to public heahh or safzty.
3� °NON-CONIPLIANI'SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-yeaz flood plain,any ISTS which may
or may not mzet all the location,desigi,or construclion standards of the cunznt Orono blunicipal Code and which is failing for any reason;and
any ISTS with lzss than three feet of unsaturated soil or sand betwezn the distribution dzvice and the limiting soil charactzristics.
T�NK CO�IDITION(5-10): ��-?�o�Se
Tanl:inspection indicates: .
� Pumpout nut nzeded at this time.
6 Tank must bz pumped out this year (cit}•code requires tanks to bz pumpzd out every 3 yeazs. Tank was last pumped ),
7 Solids accumulation in tanks is at a critical a critical levzl. Tanks should be pumped out as soon as possible.
S Systzm is discharging to the surfaca. Tanks must be pumped out within 48 hours to eliminate surface discharge.
9 lnspection riszrs missin�-tanks could not be inspected. Inspection risers(4"dia.pipz)must be installed in each tank at nzal pumpout If taiilcs
have not bezn pumped out within the last three years,they should ba pumpzd out now.
1� Inspzction pipe is locatzd directly over tank baffle(does not give accurate measuremznt of solids accumulation). Iftanks have not been pumped
ou[within the last three years,they should be pumped out now.
DRAIiVFIELD CONDITION(11-14): e��Y�o OSC
1 1 Draintield is dry,no surfacing evidrnt.
12 Somz e��idznce of surfacing,not critical yet .
l.i Drainfizld'u ssturated and visibly dischazgng untrzated e$luent to thz surface. Contact the CiTy Inspector imntediately.Repairs must be
comp(zted within 90 days.
1-� Drainfield estent and condition unknown.
COl�i'VIENTS: Neec� Sa��s ���� �ro�n� ow-1,o�se �rro� I , e�Se� sep+ � �o��t�q�-�d�
S—� — O 1 ,�1�-
Date of Inspection Sep6c System Inspector
Note: In L�e event that this inspection report is tLsed to satisfy the requirements for a moctgage or other transfer of property,be advised that this report does not guarantee
or c�rtify tFat an exiscing systzm will continue to function properly,but is merely an opinion of the adequacy of the system under cuirent conditions based on the available
informalion.
May 02 2015 09'44AM HP FaxRusty Olson 7634988290 Page 2
��� cnnesota Polfution
CpntrolAgency Compliance Inspection Form
5 �0 Lafayette Road North Existing Subsurface Sewage Treatment Systems
St Pau1,MN 5515S-4i44 (,'1T'O �gSTS�
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F�p Doc Type. Compliance and Enfo�ement
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Instructions: Inspection results based on Minnesota Paflution Control Agency(MPCA) , For local tracking purposes:
requirements nd attached forms-additional lacal requirements may also apply. I i
Submit com leted form to Local Unit of Government(LUG�arsd system owner
within 15 da s I �
System S tus
Systerrt status on date(mm/ddlyyyy): 412fi12015
� Co pliant-Certificate of Compliance C Noncompliant- Notice of Noncompliance
(Va id for 3 years from reporf date, unless shorter time (See Upgrade Requirements on page 3)
fra e outlined in Local Ordinance.)
Reaso (s) for noncompliance (check al!applicable)
❑ I pact on Public Health (Compliance Component #?)-/mminent threat to public health and safety
❑ C�ther Compliance Conditions (Compliance Component#3)-lrnminent threat to public health and safety
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❑T nk Integrity{Compliance Componenf #2j-Failrng to protectg�oundwafer
❑ ther Compliance Conditions (Compliance Component#3J-Fadrng to protect groundwafer
❑ S il Separation (Compliance Cornponent #4)-Failing to protect groundwater
❑ perating permiJmonitoring plan requirements(Compliance Component #5)-Noncompliant
i
Property 11f01'111dt1011 Parcel IDt1 or Sec/TwplRange: 231172323�036
Property addr ss: 180 Big Island, Orono, MN Reason for inspection: Property Transfer
Praperty own r: Mark Myers Owner's phane:
or
�wne�'s repr sentative: Gregg Larsen Representative phone: 612-719-4477
Local regulatdry auihority' City of Orono Regulatory authority phone: 952-249-4600
Brief system escription: _1-10Q0 and 1-500 allon lift station and 660 square feet oT chamber per city records
Comments or recommendations:
Certification
1 hereby certi that all the necessary inforrnatron has been gafhered fo defermine the compliance status of this system. No
detennination of future system performance has been nor can be made due to unknown condih�ons during system construction,
possi6le abus of the system, inadequate mainfenance, or future wafer usage.
�nspector na e� Joseph J Olson Certlfication number: 1255
Business na e: Rusiy plson's Soil&Perc.Testinq _ License number: 810
Inspector sign ture: Phone number: 763-498-8779
Necessary or Local(y Required Attachments
� Soil bori g logs � -built drawing ❑ Forms per local ordinance
❑ Other inf rmation(list):
www.pcastate. n.us • 651-246-6300 • 800-657-3864 • T'fY 651•282•5332 or 800-657-3664 • Available in altemative formats
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May 02 2015 09:44AM HP FaxRusty Olson 7634988290 page 3
Property add ss _180 Biq Island Orono,MN _ InspectorinitialslDate: J.O.4/26115
1. Impe t OIl Publ1C Hedlth—Compliance component#1 of 5
Com iance criteria: Verification method�s):
Systern discharge sewage to the '�� ❑Yes � No � Searched for surface outlet
round urface. � Searched fnr seeping in yardlbackup in home
_-- �_ _.
[ ❑ Excessive ponding in soi!systemlD-boxes
System discharge sewage to drain tile ! ❑Yes �No
or surf e waters. I ❑ Homeowner testimony(See Comments/Explanation)
❑ "Black soil"above soil dispersal system
Syslem cause sewage backup in;o ; ❑Yes � No ❑ System requires"emergency'pumping
dwellin or establishment.
— ❑ PerFormed dye test
Any"�es"answer above indicates the system is ❑ Unable to verify(See Commsnts/Explanation)
a�t/m inent Threat to Public Health and Safety. ❑ pther methods not listed (See Comments/Explanatior�)
Comm ntslExplanation:
2. Tank:Inte�rity—Compliance component#2 of 5
Com iance criteria: Verification metfiad(sj:
Syste consists of a seepage pit, i ❑ Yes � No � Probed tank(s)bottom
cesspo I,drywell,or leaching pit. ', � Examined construction records
Seepag pifs meeting 7080 2550 may be ❑ Examined Tank Integriiy Form(Attar.h)
complia t if alfowed in local ordrnance.
---– ❑ Observed liquid level below operating depth
Sewag tank(s) leak below their ; ❑Yes � No
desi n d o eratin de th. ❑ Examined empty(pumped) tanks(s}
If yes, hich sewage tank(s)leaks: ' ❑ Probed outside tank(s)for"black soil"
-�' --_ __— ---
Unable to verify(See Comments�cplenatr'on)
Any �/eS"answer a6ove indicates the ❑ pther methods not listed (5ee CommentslExplanation)
syste is Failing to P�otect Grourrdwater.
Comm nls/Explanation:
3. Othe Comp lidnCe COrlditi0n5—Compliance component#3 of 5
a Mai��ienance hoie covers are damaged,cracked,unsecured,o�appear to structurally unsound. ❑Yes" �No ❑UnknoHm
b. Oth�r issues(elechical hazards,etc.}to immediately and adversely impact public health or safety. ❑Yes* �No ❑Unknown
"S tem is an imminent threat to public health and safery
Ex lain:
c Sysjtem+s non-protective of ground waterfor other conditions as determined by inspector ❑Yes" �No
*S tem is failing to protect groundwater
Ex lain:
www.pca.stat .mn.us • 651-296-6300 • 800�657•386a • TTY 651-282-5332 or 800•657-3864 � Available in altemat've formats
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May 02 2015 09:44AM HP FaxRusty Olson 7634988290 page 4
Property add ess: 180 Big Island, Orono MN _ Inspector initials/Date: J. O.4l26/15
4. SOiI S paretiotl —Cornpliance camponent#4 of 5
Date f installation: 10/10l03 ❑ Unknown Verification methad(s):
Shorela d1YYellhead protectionlFood Beverage
Lodgin � �Yes ❑ No Soi!observafion does nof expire. Previous soil
� obse�vations by two rndependent parties ar�suficient,
Comp�iance criteria: unless site conditrons heve been altered orloca!
I requiremenfs differ.
For sys ems built prior to Apri!1, f 995, and � ❑ Yes ❑ No
not loc fed in Shoreland or Wellhead � � Conducted soil observation(s)(Attach bonng logs)
Profecf n Area ornot serving a food, , ❑ Two previous verifications(Attaeh boring iogs)
bevera�e or lodging establishment: I ❑ Not applicable(Holding tank(s),no drainheld)
Drainfi Id has at least a two-foot vertical I ❑ Unable to verify(See CommentsiExplanat;on)
separat on distance irom periodically , ❑ pther(See Comments/Explanation}
saturat d soil or bedrack.
Non-pe ormance systems builf April 1, i � Yes ❑ No CommentslExplanafron:
9996, o laterorfornon-performance i
system located in Shoreland or We!lhead '
Protect n Areas orserving a food,
bevera e, or lodging establishment: �i
Drainf d has a three-foot vertical �'
separa�on dislance from periodicafly I,
saturat d soil or bedrock.'
, �
"Experrro�ental'; °Othe�'. or "Performance" � ❑ Yes ❑ No Indicate depths of elevations
sysfem$built under pr�-2008 Rufes; Type!V �
or V sy tems burlt under 2008 Rules(7080. , A. gottom o'distribution media 95.8
2350 or�7080.24�0 (Advanced Inspector I ;
Licensel requited) � B. Periodicall saturated soil/bedrock 93.2
Drainfie d meets the designed vertical G S stem se aration 2.6
separat on distance from periodically
saturat d soil or bedrock. j D. Required cornpliance separation" ; 2.6
Any " o"answer above indicates the system is •May be reduced up to 15 percent if allowed by Local
Failin to Protect Groundwater. Ordinance.
5. Oper ting Permit and Nitrogen BMP*- compiiance component#5 ot 5 � Not applicable
Is the sy em operated under an Operaiing Permit? ❑ Yes ❑ No If"yes",A below is required
Is the sy em required to employ a Nitrogen BMP? ❑ Yes ❑ Na If"yes", B below is required
BM Besf Management Practice(sJ specifred in the system design
!f fhe answer to both quesfions is "na", this section does not need to be comp/eted.
Compliaince criteria
a. Op�rating Permit number: ' ❑
� Hav�e the Operating Permit requirements been met? Yes ❑ No
b. Is t e re uired ritro en BMP in place and properiy functioning? I ❑ Yes ❑ No
Any "n "answer indicates Noncomp/iance,
Upgrade equ irements (M,inn. Stat. §115 55)An imminent threat to public health and safety(1TPKS)must be upgraded,replaoed,or rts use
disconfinu d within ten months of receipf of this notice or within a shorter period if required by local ordinance.!f the system is failing fo protect
ground we er, the system must be upgradeU,replaced, or its use discontinued within the 6me required by loca!ordinance.!f an existing system
is not failin as defined in law,and has at least two(eet of design soi!separation,then tne system nsed not be upgraded,repaired,replaced.or
its use di ntinued,notwithstanding any loca!ordinance that is more str�cf. This provision does no;apply to systems in shoreland areas,
Wellhead rotection Areas,or ihose used in conneCtion with food,beverage,and lodging eslablishments es defined in law.
www.pcas[ate.�n.us • 651-296-6300 • 800-657-3864 • TTY 651•282-5332 or 800•657-3864 • Available in alternative formats
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May 02 2015 09:44AM HP FaxRusty Olson 7634988290 page 6
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Loqs of Soil Borinps
License�t810
Locatio or Project: 180 Big Island
Borings made by: Rusty Olson's Soii and Perc testing 41261Z015
Classifidation System: AASHO ; USDS-USDS�SCS X ; Unified ; Other
Auger u$ed (check two): Hand_X_, or Power_,Flight,Bucket or Probe_X_
Bonng N�mber_1_Surface elevation_96.3_ Mottled Soil at_3.3_feet
0"-8" Dar�k brown loam 10yr3l2 H20 present at_X_
8"-32" Br�own clay loam 10yr4/4
32"-40"�rown Ioam10yr514
Boring NII mber_2_Surface eievation_95.8_ Mottled Soil at_2.6_feet
0"-8" Da k brown loam 10yr3l2 H20 present at_X_
B"-26" B wn clay loam 10yr4/4
26"-32" �rown loam 10y5/4
32"-42" F2usty Brown loam 10y5/4
TBM: To of well Elv.-100.00 assumed
Bottom chamber Elv.-95.8