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Home My WebLink About05-04-2023 Septic Compliance inspectionM MINNESOTA POLLUTION Compliance n ance inS ection report form CONTROL AGENCY 1" p h' 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,/wg wwists4-31a.odf. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: 0611723230009 Reason for Inspection Propery Transfer Local regulatory authority info: City of Orono Properly address: 4740 North Arm Drive West Owner/representative: John Hedberg Owner's phone: 952-472-3369 Brief system description: 1 -2000 -gallon combination septic tank, 1 -1000 -gallon lift station and 500 square feet of mound rock bed per City records. System status System status on date (mmlddlyyyy): 5/4/2023 ® Compliant — Certificate of compliance* (Valid for 3 years from reportdate 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 #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 1.9 feet of sand under the North end of the rock bed. There is 1.0 feet of sand under the South end of the rock bed. TBM: Top of the garage concrete slab. ELV.-100.0 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 (This document has been electronically signed) License number: L810 Necessary or locally required supporting documentation (must be attached) Phone: 763-498-8779 ® 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 500-657-3864 Use your preferred relay service - Available in alternative formats wq-wwists4-31b - 4/28/1021 Page l of 4 Property Address: 4740 North Arm Drive West Business Name: Rusty Olson Soil & percolation Testing Date: 5/4/2023 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 I ❑ Yes- ® No 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 Attached supporting documentation: ❑ Other: ® Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: Attached supporting documentation: System consists of a seepage pit, ❑ Yes' ® No ❑ Empty tank(s) viewed by inspector cesspool, dryweil, leaching pit, or other it? Name of maintenance business: Sewage tank(s) leak below their ❑ Yes` ® No License number of maintenance business: 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: Elmer J. Peterson Company pumped the tanks. Date of maintenance: ® Existing tank integrity assessment (Attach) Date of maintenance 5/1/2023 (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: 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 2 of 4 Property Address; 4740 North Arm Drive West Business Name: Rusty Olson Soil & percolation Testing Date: 5/4/2023 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) ❑ https://www.pca.state.mn.us 651-296-6300 840-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 3 of 4 Property Address: 4740 North Arm Drive West Business Name: Rusty Olson Soil & percolation Testing 5. Soil separation — Compliance component #5 of 5 Date of installation 8/27/1986 ❑ Unknown (mm/dd/yyyy) ShorelandlWellhead protection/Food ❑ Yes ® No beverage lodging? Comoliance 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 stablishment: 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, orlodging 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 1V 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. [:]Yes ❑ No* ❑ Yes ❑ No* *Any "no" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Date: 5/4/2023 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 103.2 B. Periodical!y saturated soil/bedrock 101.0 C. System separation 2.2 D. Required compliance separation* 2.0 *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.rnn.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 UNIVERSITY OSTP As -Built Form OF MINNESOTA Owner: D We- 4AV, Parcel Number. 0,41 Street/City/Zip Code: 7 ;P�' AALZ " Lot: Section: Township: N Range: W Installation Date: C — 17 `~ lnstaller:" L License Number: is the system in Shoreland, serving a MDH facility or in a Welhead Protection area? ❑ YES ❑ NO Number of Bedrooms/ Flow Rate: # / gpd Septic Tanks, No & Size: a".Do4 #/gal C' Pump Tank Size: A:�� gal Tank Manufacturer: Pl-ez,4 idf Model # Date of Manufacture: P-0/0 Maximum Burial Depth: ;2-v "-- S 5 Pump Size: hp gpm ft of TDH Floats properly set? ❑ YES ❑ NO Soil Treatment Area: ❑ TYPE I 0 TYPE 11 ❑ TYPE111 ❑ TYPE IV ❑ TYPE V ❑ TRENCH ❑ BED Rr MOUND ❑ AT -GRADE❑ WARRANTIED ❑ OTHER: Limiting Layer/Depth: " Rockbed Size: Describe: Depth from Surface: " Adsorption width: Rock or Slat depth: Sand depth:, Diameter of Gravelless: " (under mound) Trench Width: 10 Bottom Square Feet Area: ftz Design Variances: Site Drawing: p) �- 9,3 North 1 115 I P3 A3 -8 L J� ,l rem Hb L"2F Items to be Identified: Z. Septic, holding and pump tanks, piping, and soil system configuration. Label bed or trench width and length or rockbed size, absorption width and final dimensions. Indicate alarm location. 2. Show all setbacks from tank and soil system a. Property boundries b. Buildings c. Wells d. Water bodies e. Road right-of-way 3. Improvements - present and future. 4. Benchmark location and distance of tank and soil system from benchmark 5. Replacement site 6_ Abandoned system Reverse Side SEPTIC SYSTEM INVENTORY Site Address: 4740 North Arm Dr W PID 06-117-23-23-0009 Owner Name: John & Janice Hedberg Owner Address: 4740 North Arm Dr W Mound MN 55364- BuildingType: residence Installer: E. J. Peterson, E. J. Peterson Co. Date of Permit: 8/27/86 System Type: mound BR's Designed for 4 In Musa?: No Shoreland?: SEPTIC TANKS: Material: concrete blk & prest Capacity: 2000, 1000 Tank Filter: DRAINFIELD: Treatment Area: 87*42 Soil Boring: no DF Ht above Wt: 3 WELL, DATA Setbacks - Well Tanks, 50 Well DF: 50 Report In File: Depth: 110 INSPECTION RECORDS Date Notes 8/17/2010 new 2000 gallon septic tank 8/25/2003 no surfaci ng,pum p tanks 8/16/2001 compliant system, no surfacing 11/8/1999 no surfacing 4/22/1997 no surfacing -pump tanks 8/24/1993 no surfacing 9/23/1991 no surfacing 8/21/1990 no surfacing 9/9/1986 install pump tank and mound DF 7/1/1986 DF surfacing 10/24/1985 DF surfacing 7/19/1982 no surfacing 7/19/1982 no surfacing ok PUMPOUT RECORDS Date CallonsbfLiquid 6/13/2019 2000 12/2/2015 2000 8/15/2012 3000 8/17/2010 0 10/20/2008 2000 8/6/2004 2500 5/19/2000 1500 7/28/1994 2000 2/1/1991 1800 1/1/1990 1200 11/1/1985 1200 4/14/1983 1800 4/14/1983 1800 Elmer I Peterson Co. 5021 Dague Ave. Delano, MN 55328 Phone 768-972-2420 Fax 763-972-72 17 MPGA License# 219 John Hedberg 4740 North Arm Drive Orono, MN 952-472-3369 Baffles: e / OFF Tank Capacity: # of Tanks: 2 Type of Tanks: _ Gallons Pumped: Tank Report Date: May 1, 2023 1-1500 Gallon Compartment Tank, 1-1000 Galion Pump Tank Concrete 2000 Manholes to Grade: LS / NO C:otntnents: On May 1, 2023, Elmer J. Peterson Co. pumped tanks and cleaned filter in 2n' tank. No cracks or water leaking in tanks at the 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. M MINNESOTA POLLUTION Sewage tank integrity assessment farm CONTROL AGENCY 520 Lafayette Road North Subsurface Sewage St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program Doc Type: Compliance and E'nfftement 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 entirety completed and signed by a qualified professional. SSTS compliance inspection report forms can be found at: httpsa/www.oca.state.mn-us/water/insDections. 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. 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 - Existin system (wci-wwists4-31 b). This form can be found on the MPCA website at httos://www.pca.state.mn.us/waterfnspections. 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(8)(1). This form is valid for a period of three years beyond the signature date an 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(0). Owner information Owner/Representative John Hedberg Property address: 4740 North Arm Drive, Orono, MN Local Regulatory Authority: System status System status on date (mmlddlyyyy): 5/112023 Parcel iD: ® 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." The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect 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 Public Health or Safety." Any "yes" answer above Indicates sewage rank non-compliance. ❑ Yes' ® No ❑ Yes' ® No [--]Yes* ® No Company information Designated Certified Individual (DCI) information Company name: Elmer J. Peterson Co Print name: James L Braqgelmann 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. 1 personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS_ By typing/signing 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 Braegelmann Date (mm/ddlyyyy): 5/11_2023 (This document has been electronically signed.) www.Pca.Mte.rnr.us wq•ww15t54-91 • 5/10/21 • 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats Page 1 of 1 Soil Observation Log www.SeptieResource.com vers 12.4 Owner Information Property owner / project: John Hedberg Date 5/4/2023 Property Address / PID: 4740 North Arm Drive West Soil Survey Information. ❑ refer to attached soil survey Parent matl's: R] Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock landscape position: ❑ Summit ❑ Shoulder 0 Side slope ❑ Toe slope soil survey map units: L41 h slope % direction- Lineal Soil Log #1 0 Boring ❑ pit Elevation 104.8 Depth to SHWT 44 Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape <35 loose loose single grain 0-30 Fill mound sand 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive 30-36 Loam <35 10yr3/1 Friable Moderate Blocky 36-44 Clay Loam <35 1 Oyr4/3 Friable Strong Blocky 44-48 Clay Loam <35 1Oyr5/4 10y4/8,1 -6/10y Firm Strong stocky X35 loose loose single grain 35-50 friable weak granular blocky X50 firm moderate prismatic platy rigid strong massive Comments: TBM: Top of the garage floor concrete slab. ELV- 100.0