HomeMy WebLinkAbout03-15-2023 Septic Compliance inspection reportM MINNESOTA POLLUTION re Compliance inspection ort form
CONTROL AGENCY p p 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 https://www.i)ca.state.mn.us/sites/defaulttfiles/wq-wwists4-31a odf.
Property information Local tracking number:
Parcel IQ# or Sec/Twp/Range: 0511723120017 Reason for Inspection Propery Transfer
Local regulatory authority info: _City of Orono
Property address: _3415 High Lane
Owner/representative: Garth Johnson (Realto
Owner's phone: 612-670-0159
Brief system description: Approximately 2 -1000 -gallon septic tanks with a filter in the second tank, 1 -1000 -gallon lift station and 400
square feet of mound rock bed.
System status
System status on date (mm/dd/yyyy): 03/15/2023
® 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 (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
❑ Other Compliance Conditions (Compliance component #3) — Failing to protect groundwater
❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component 93) — 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 rock bed.
TBM: Bottom of the rock bed. ELV.-100.0
The system was designed for an at -grade. The installer opted for a three bedroom mound system with 1.0 feet of sand.
The soils were verified by the city to have redox at 38-40 inches.
There is a filter in the second tank. This will need cleanino oeriodicaliv.
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: 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):
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Property Address: 3415 High Lane
Business Name: Rusty Olson Soil &percolation Testing Date: 03/15/2023
1. Impact on public health — Compliance component #1 of 5
Com liance 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
dwellingor establishment.
Any "yes" answer above indicates the system is an
imminent threat to public health and safet .
Describe verification methods and results:
Visual. Nothing was found
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 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.
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 3/8/2023 _
(mmlddlyyyy): (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:
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Property Address: 3415 High Lane
Business Name: Rusty Olson Soil & percolation Testing Date: 03/15/2023
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) ❑
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Property Address: 3415 High Lane
Business Name: Rusly Olson Soil & percolation Testing
S. Soil separation — Compliance component #5 of 5
Date of installation 9/16/2009 ❑ Unknown
(mmlddlyyyy
ShorelandlWelihead 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.*
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 :5
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.
Date: 03/15/2023
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 city-
® Yes ❑ No* Indicate depths or elevations
❑ Yes [:]No*
*Any "no" answer above indicates the system is
failing to protect groundwater.
Describe verification methods and results:
A. Bottom of distribution media 100.0
B. Periodically saturated soil/bedrock Greater than
97.0
3.0
D. Required compliance separation* 1 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 derined 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,
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Page 4 of 5
beverage, and lodging establishments as defined in law.
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wq-wwists4-31b • 4/28/2021
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Page 5 of 5
Tank Report,
Date: March S, 2023
Elmer I Peterson Co,
5921 Dague Ave.
Delano, MN 55328
Phone 763-972-2420
Fax 765-972-72 17
MPGA License# 218
3415 High Lane
Orono, MN
612-670-0154 Garth Johnson - Realtor
Raffles: W1
Tank Capacity:
# of Tanks: 3
"Type o#'Tanks: _
Gallons Pumped:
OFF
3-1000 Gallon Tanks Per City Records
Concrete
2500
Manholes to Grade: ES / NO
Comments:
On March 8, 2023, Elmer J. Peterson Co. pumped tanks and cleaned filter in 27Ld tank. No cracks or water
leaking in tanks at tate 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.
MINNESOTA POLLUTION Sewage tank integrity assessment form
CONTROL AGENCY g g y
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:flwww,pca.state.mn.us/water/inspections.
Instructions: This form may he 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 inspection form - Existing system (wg-wwists4.31 b). This form can be found on
the MPCA website at htt s:!lwww oca. state.mn.us/wakefinspections.
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(B)(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. 7082.070C, subp. 4(B),(C),
and (D) and; Minn. R. 7083.4730(C).
Owner information
Owner/Representative Garth Johnson (Realtor)
Property address: 3415 High Lane Orono, MIN
Local Regulatory Authority: _ Parcel ID:
System status
System status on date (mm/dd/yyyy): 318/2023
® 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." ❑ Yes" ® No
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect
Groundwater." ❑ Yes' ® No
The SSTS presents a threat to public safety by reason of structurally unsound (damaged, cracked,
or weak) maintenance hole covers) or lids or any other unsafe condition - "Imminent Threat to ❑ Yes- ® No
Public Health or Safety."
Any "yes" answer above indicates sewage tank non-compliance.
Company information Designated Certified Individual (DCI) information
Company name: Elmer J. Peterson Co Print name. James L Brae2elmann__
Business license number: 219 - Certification number:
I personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection,
maintenance, installation, or service provider Business. I personally conducted the necessary procedures to assess the compliance
status of each sewage tank in this SSTS.
By typingisigning 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.
Designated Certified Individual's signature: James L Brae elmann Date (mmiddiyyyy); 3/8/2023
(This document has been electronically signed.)
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wq-wwists4-91 • 3/10/21
Page I of 2
Logs of Soil Borings
License #810
Location or Project: 3415 High Lane
Borings made by: Rusty Olson's Soil and Perc testing 816/2009
Classification System: AASHO USDS- USDS-SCS X Unified ; Other_
Auger used (check two): Hand _X_, or Power , Flight, Bucket or Probe —X—
'Boring Number _1_ Surface elevation _66.6
0"-18" Dark brown loam 10yr3/2
18"-24" Brown loam IOyr4/4
24"-38" Brown loam 10yr5/4
-44" Rusty brown loam 10yr5/4
Boring Number _2_ Surface elevation 63.5
0"-18" Dark brown loam 10yr3/2
18"-32" Brown loam 10yr4/4
32"-44" Brown loam 10yr5/4
-50" Rusty brown loam 10yr5/4
Boring Number —3— Surface Elevation —66.6—
W-1 8"
66.50"-18" Dark brown loam 10yr312
18"-24" Brown loam 10yr4/4
24"-38" Brown loam 10yr5/4
38"44" Rusty brown loam 10yr5/4
Mottled Soil at -3. 1feet
H2O present at _X_
Mottled Soil at 3.7 feet
H2O present at _X_
Mottled Soil at 3.1 feet
H2O present at _X_
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CITY OF ORONO
INSPECTION NOTICE
PERMIT NO.....
ADDRESS
OWNER
TELEPHONE NO.
DESCRIPTION
CALLED IN
SCHEDULED
COMPLETED
~�
1-4 �,- (,
DATE
TIME
CONTR.
❑ FOOTING
❑ MECHANICAL RI
❑ FRAMING
❑ MECHANICAL FINAL
❑ INSULATION
❑ WOOD BURNER!FIREPLACE
El WALL BD.
❑ WATER HOOK-UP
❑ FINAL
❑ SEWER HOOK-UP
❑ DEMO - SITE
❑ SEPTIC MAINT.
❑ DEMO - FINAL
❑ SEPTIC INSTALL.
❑ PLUMBING R#
❑ SEPTIC FINAL
❑ PLUMBING FINAL
FOUNDATION/REMOVAL
OWNER/CONTRACTOR TO MEET YOU: — YES _ NO
COMMENTS:
❑
EXCAV/GRADING,'FILLING
❑
LAKESHORE/WETLANDS
❑
TREE REMOVAL
❑
STE INSPECTION
❑
PROGRESS
❑
COMPLAINT
❑
FOLLOW-UP
❑
HARD COVER REMOVAL
❑
FOUNDATION/REMOVAL
For
WORK SATISFACTORY: PROCEED
it CORRECT WORK & PROCEED
CORRECT WORK, CALL FOR REINSPECTION
BEFORE COVERING
U CORRECT UNSAFE CONDITION WITHIN HOURS.
INSPECTOR WILL RETURN
0 STOP ORDER POSTED_ CALL INSPECTOR
El INSPECTION REQUIRED. CALL TO ARRANGE ACCESS.
E PROJECT COMPLETE
ISSUE CERTIFICATE OF OCCUPANCY
TEMPORARY
PERMANENT
PHOTO TAKEN
CITATION ISSUED
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site:
Inspector.
White Copytnspeor_ s File
b
Canary Copy/Site Notice
V
SEPTIC SYSTEM INVENTORY
Site Address: 3415 High La
Owner Name: Richard Marklund
Owner Address: 3415 High La Long Lake MN 55356 -
PID 05-117-23-12-0017
BuildingTvpe: residence Installer: Burns Excavating
Date of Permit: 09/15/09
Svstem Tvpe: mound BR's Designed for 3
In Musa?: No Shoreland?: No
SEPTIC TANKS:
Material: concrete precast Capacity: 1000, 1000,1000 Tank Filter:
DRAINFIELD:
Treatment Area: 760 Soil Boring: yes OF Ht above Wt: 3
WELL DATA
Setbacks - Well Tanks: 50+ Well DF: 75+ Report In File: Depth: 182
INSPECTION RECORDS
Date Notes
11/1/2009 New mound System
6/1/2006 Non-compliant, replace by 12/31/2010
8/14/2002 non-compliant,replace by 12/31/2010
6/6/2000 non-compliant, repair by 12/31/2010
7/23/1997 non -compliant -repair by 12/31/2007
6/10/1993 no surfacing -pump tanks
5/21/1991 no surfacing
7/8/1987 no surfacing
7/14/1986 no surfacing
8/27/1982 no surfacing
8/27/1982 no surfacing
PUMPOUT RECORDS_
Date GailonsOfLiquid
8/31/2017
2500
11/1/2009
0
4/28/2009
1000
7/13/2005
1000
7/1/2002
1000
8/4/1998
1000
10/19/1990
800
7/1/1987
1500
4/1/1983-
500
4/1/1983
------- ---
500
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