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HomeMy WebLinkAbout11-20-2022 Septic Compliance Inspection ReportMINNESOTA POLLUTION Compliance inspection report form CONTROL AGENCY h' p N 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 https://www.pca.state.mn.us/sites/default/files/wq-wwists4-31a.pdf. Property information Local trackina number: Parcel ID# or Sec/Twp/Range: 361 1 8231 30007 Reason for Inspection Property Transfer Local regulatory authority info: City Of Orono, (952) 249-4600 _ Property address: 507 Ferndale Road N., Orono Owner/representative: Kitty Onan Owner's phone: 612-242-7046 Brief system description: 2 -1250 -gallon septic tanks, 1 -1250 -gallon lift station and 630 Square feet Rock bed System status System status on date (mm/ddlyyyy): 11/20/2022 ® 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. ❑ 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 #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 1.0 feet of sand under the rack bed. Need to get power to the alarm box in the mechanical room per the pumper. 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, 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 _ 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 wq-wwists4-31b • 4/28/2021 Use your preferred relay service Available in alternative formats Page 1 of 4 Property Address: 507 Ferndale Road N., 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 ground surface ❑ Yes" ® No System discharges sewage to drain ❑ Yes" ® 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: 11/20/2022 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 it? Sewage tank(s) leak below their [--]Yes* ® No designed operating depth? If yes, which sewage tank(s) leaks: Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Duane's 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 10/22/2022 (mm/dd/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 o14 Property Address: 507 Ferndale Road N., Orono Business Name: Rusty Olson Soil & percolation Testing Date: 11/20/2022 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* ® 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) ❑ 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 Page 3 of 4 Property Address: 507 Ferndale Road N., Orono Business Name: _ Rusty Olson Soil & percolation Testing Date: 11/20/2022 S. Soil separation — Compliance component #5 of 5 Date of installation 6/10/1994 ❑ Unknown (mmiddiyyyy) Shoreland/Wel I head 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 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.* ❑ Yes ❑ No* 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: 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 98.0 B. Periodically saturated soil/bedrock 95.0 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 (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-ww1sts4-31b • 4/28/2021 Page 4 of 4 M MINNISOIAA PQil ;tt+ON CONTROL Sewage tank integrity assessment form CONF .•' u! iWrrr WJE i AliNt'+ Subsurface Sewage Rit i''y "i,"i y' Treatment Systems (SSTS) Program Prop.rty aiiiar=a City - Purpose: This fCrin may be to ck�rtity the compliance status of the sewage tank components of the SSTS This form is not a compleb SSTS inspection report, only a tank integrity assessment, and may only certify sewage tank comptiance status when entirely completed and signed by a qualified professional. SSTS compliance inspection report forms can be found at Instructions: This form may be completed, and signed• by a Designated Certified Individual (DCI) of a licensed SSTS inspection maintenance. Installation, or sennce provider business who personally conducts the necessary procedures to assess the compliance status of each sewage tank in the system A copy of this inkmation 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 st44por6np documentation to an Existing System Compliance inspection Report This form can be found on the MPCA website at P rvp , - 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 parry assessment of SSTS component compliance and is allowable under Minn R 7062.0700 subp 4 Item (B) subitem (t). 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 of is required according to local regulations Additional Administrative Rule references for this activity can be found at Minn R 7082.0710. subp 4 Items B. C. and D. 7083 0730 Item C 7� Certificate of sewage tank compliance Affirm all three statements The SSTS does not contain a seepage pit. cesspool, dryweil, leaching pit, or other pit It does not contain a sewage tank that was designed to be watertight• but subsequently leaks below the designed operating depth It does not represent an imminent safety threat by reason of unsecured. damaged, or weak maintenance hole cover(s) or other unsafe condition Notica of sewage tank non-compliance Select ail that apply ❑ The SSTS has a seepage pit• cesspool, drywelf leaching pit. or other pit — -Failure to Protect Groundwater." It has a sewage tank that was designed to be watertight, but subsequently leaks below the designed operating depth —"Failure to Protect Groundwater." ❑ it presents a threat to public safety by reason of unsecured damaged or weak maintenance hole cover(s) of other unsafe condition w1mminent Threat to Public Health or Safety.' Company information Designated Certified Individuai (DCI) information Company name: Duane's Septic Service Print name Business license number. 654 Certification number I personally conducted the work described above as a Designated Cert flied Individual of a Allinnesata-hcensed SSTS rnswc1m maintenance installadon, or service provider Business f personally condWed the necessary procedures to assess lire comphance status of eactr sewage tank in this SSTS By typinoigning my mune below. 1 certify the above statemepts to be true and correctto the best of my knowledge, and that this infurrrration can be used for the purpose ofprocessing r9trs form Designated Certified individual's signature: Date (mmlddlyyyy): (This doc xnent has Bean el6cfrpniceNy &geed , www mi. state Mn.sn bs r.lay w1,)0 800-657 3664 use your pnitrred n"V +trace 4vaiabie'n aitemame f0muIS wv wwesLsd-97 + !/5/21 Frage t aft Jim Eicher Maintenance Inspection Form MPCA Lic. # 654 Maintainer [:3 Jim ED Duane p L� Nick Septic Service, LLC - Phone: 763-497-2764 1245 LaBeaux Ave NE St. Michael, MN 55376 - Email: duaneseptic@centurylink.net DATE _INVOICE Pumping Fee: Name: Long Pull Fee: Address: ❑ Et w§W dre[rwbtd Q Baffin 0 BdIIBO Other Repairs: - CitylState2ip: Q Ncin-dDmesft wade I C Ef%M F0Wi5r3eDn Total Cost of Service: Clbened7 C Yee ❑trio Payment Method: ❑ Check ❑ Cash O Credit Tank leaks 113010W the Tank leaks above the Rla#ntenance hole cover is damaged, Tank (check if present) designed operating depth designed operating depth cracked, unsecured, or appears to de StrUCturaily unsound #dJhong Tank 1 Gs GaJ[onllons: U Yes No L Yes L) 'No ❑ Yes Q No 13 Septicftiding Tank #2 t Gallons: � � Yes Q No � Yes C3"No Q Yes 7 No } Q Pretreatment Tank Gallons: Yes Q Nv L7 Yes ❑ No Cl Yes No ' Pump Tank Gallons: I G C Yes ff No D Yes 0- No Q Yes Q No ScumlSl ulige Measured I Maintenance C Other (see attached) ! Yes a No 1 © Yes Replaced. I Reason For Pumping. ❑ No W yW kfeodfY wyY ap&atbnal 1s5,._, .s. u;rwlr _.. 44bris wade asses. V the SEwage tankS m Mk system, [.e., aacxed tesla, mrss ' ov-5 e!r_ !r s, �pratn en cam,ncn[s beAon. gs LINO Tank t2 --- .4 ' - ' Yes ❑ No System ❑ stn/Cuw 4Neprlljf Q r. t. . - _ - - 0 A"WS IDA" ci Roas iO"Ov ❑ Et w§W dre[rwbtd Q Baffin 0 BdIIBO ❑ Pi w xe Wd L7 Non-dornesoc waste :1 NOrrdome ❑ Trendies ...;u[al raegntY171-Mound Q Elms ieekirX] ❑ Et w§W dre[rwbtd ❑ EWA%@ ❑ Pi w xe Wd Q Ebcail et I6SUett ❑ Trendies Q Ncin-dDmesft wade ❑ PQf4[[7gj$ur4" C Ef%M F0Wi5r3eDn ❑ 0lhW Clbened7 C Yee ❑trio Comments. Dispose: C Land AppGCabon C llmsieweler Tnmwn v Pl.rn Disposal Site: Time: Time: Low Gallons t Temperature Ternpeiraiure: Plowed h Yes Na-- PH Soil Observation Log www.SepticResource.com vers 12.4 Owner Information Property Owner / project: Date 11/16/2022 Property Address / PID: 507 Ferndale Road N. Soil Survey Information ❑ refer to attached soil survey Parent matl's: [] Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ Summit ❑ Shoulder El Side slope ❑ Toe slope soil survey map units: L22t_;2 slope % direction - Soil Log #1 2 Boring ❑ Pit Elevation 105.6 Depth to SHWT 20 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-6 Loam <35 10yr3/2 Friable Strong Biock�, 6-20 Clay Loam <35 10yr5/4 Friable Strong Block-} 20-26 Clay Loam <35 10yr6/4 10y418,1 -6/10y Firm 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 >50 firm moderate prismatic platy rigid strong massive Comments: 507 Ferndale Road N. Soil Log #2 p Boring ❑ Pit Elevation 109.7 Depth to SHWT 16 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-12 Loam <35 10yr3/2 Friable Strong Blocky 12-20 Clay Loam <35 10yr5i4 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 >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 507 Ferndale Road N. Soil Log #3 Q 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 >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 <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 strong massive <35 loose loose single grain 35-50 friable weak granular blocky >SO firm moderate prismatic platy rigid strong massive I hereby certify this work was completed in accordance with MN er Signature 7080 and any local reqs. Rusty Olson's Soil & Perc Company 810 License # s {�(���{/��,fJ TV J c l 14 0 HO s