HomeMy WebLinkAbout05-03-2023 Septic Compliance ReportSeptic System Compliance Inspection
For property located at:
511 Ferndale Road North
Orono, MN 55391
Prepared For:
Mark & Barbara Capece
Prepared By:
M S T S
Miller's Sewage Treatment Solutions
a division of WRM Services, Inc.
9075 155' Street
Kimball, MN 55353
May 9, 2023
M�MINNESOTA POLLUTION Compliance inspection report form
CONTROL AGENCY
520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS)
St. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement
Instructions: Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached supporting
documentation — additional local requirements may also apply. Further information can be found here:
https://www.pca.state.mn.us/sites/default/files/wg-wwists4-31 a.pdf.
Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final
determination of compliance or noncompliance.
Property information
Parcel ID# or Sec/Twp/Range: 3611823130012
Property address: 511 Ferndale Road N, Orono
Owner/representative: Mark & Barb Capece
Brief system description: 2- 1000 Gal. Septic tank, 1000
System status
System status on date (mm/dd/yyyy): 5/3/2023
® Compliant — Certificate of compliance*
Local trackina number:
Local regulatory authority: Henn
(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.
Owner's phone: 612-325-6420
tank, and mound.
❑ Noncompliant — Notice of noncompliance
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.
Systems failing to protect ground water must be upgraded,
replaced, or use discontinued within the time required by local
ordinance.
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
At the time of inspection the home was occupied and the septic system was in use. Everything was found to be in proper
operating condition.
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: Miller's
Inspector signature: Jei
e Treatment Solutions
Georae
(This document has been electronically signed)
Certification number: 7485
License number: 1921
Phone: 320-398-2705
Necessary or locally required supporting documentation (must be attached)
® Soil observation logs
® Other information (list):
additional septic info.
® Locally required forms ❑ Tank Integrity Assessment ❑ Operating Permit
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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.
Attached supporting documentation:
❑ Other:
❑ Not applicable
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:
-A hydraulic test was perfomed on the mound via the pump. No evidence of any hydraulic issues.
-No issues regarding the septic system were ever mentioned by the owner.
2. Tank integrity — Compliance component #2 of 5
Compliance criteria:
System consists of a seepage pit, [--]Yes* ® No
cesspool, drywell, leaching pit,
or other pit?
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:
Attached supporting documentation:
❑ Pumped at time of inspection
Name of maintenance business:
License number of maintenance business:
Date of maintenance:
® Existing tank integrity assessment (Attach)
Date of maintenance 5/5/2023
(mm/dd/yyyy): (must be within three years)
(See form instructions to ensure assessment complies with
Minn. R. 7082.0700 subp. 4 8 (1))
❑ Tank is Noncompliant (pumping not necessary — explain below)
❑ Other:
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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:
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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ADDITIONAL COMPLIANCE INSPECTION INFORMATION
Owner: Mark Capece
Location: 511 Ferndale Rd. N, Orono
PID#: 3611823130012
Date: 5/3/2023
Additional Construction Information
Type: _ 2-1000 gal. septic tank -1000 gal. pump tank- mound _
System classification at time of install: standard
Age of the system? _26 years_
Was the system inspected by the Local Unit of Government (LUG)? Yes
Was the system designed by a Licensed or Registered Designer? Yes
How many bedrooms was the design for? _4
Was the system installed by a licensed or registered Installer? Yes_
Operational status:
Does the system show any visual signs of stress? Not at the time of inspection. There is no telling how long the
system will continue to operate, but the system was operating at the time of the inspection with no evidence to
suggest the system is becoming an imminent public health threat.
System Maintenance:
Has the septic tank ever been pumped prior to this inspection? Yes.
Disclaimer:
Based on what we are able to observe and on our experience with septic systems, we submit this inspection report
based on the present condition of the system. Miller's Sewage Treatment Solutions has not been retained to warrant,
guarantee, or certify the proper functioning of the system for any period of time in the future. Because of the
numerous factors which may affect the proper operation of a septic system, as well as the inability of our company to
supervise or monitor the use or maintenance of the system, this report shall not be construed as a warranty by our
company that the system will function properly for any particular time. Miller's Sewage Treatment Solutions herby
disclaims any warranty, either expressed or implied, arising from the inspection of the septic system or this report. We
are also not ascertaining any effect the system is having on the ground water.
MSTS
a division of WRM Services, Inc.
9075 155th Street
Kimball, MN 55353
Phone: (320) 398-2705 Fax: (320) 398-2075
www.millerssewa eg com
Site Sketch
Owner: Mark Capece
Location: 511 Ferndale Rd. N, Orono
PID#: 3611823130012
Date: 5/3/2023
Method used to determine seasonal water table: Soil Boring, probing, records.
Soil Boring
1
Ground elevation @ boring
100.0
Depth of Boring
2 ft.
Seasonal water table depth or elev.
98.5
Standing water table depth or elev.
NA
Limiting layer depth or elev.
98.5
Sampling Location
A
Ground elev. @ sample location
104.17
Depth to bottom of drainfield media
2.17 ft.
Elev. of bottom of drainfield media
102.0
System Separation
3.0+ft.
Not to Scale
MSTS
a division of WRM Services, Inc.
Phone: (320) 398-2705 Fax: (320) 398-2075
www.millerssewa eg com
Soil Boring Loa
Owner: Mark Capece
Location: 511 Ferndale Rd. N, Orono
PID#: 3611823130012
Date: 5/3/2023
Observation #-1—
Depth
1
Depth
in
inches
Texture
Matrix Color
Redox. color
Rock fragment %
0-15
Loam
10yr 2/2
< 35%
15-18
Sandy clay loam
10yr 4/3
< 35%
18-24
Clay
10yr 4/4
1Oyr 6/6+6/1
< 35%
Depth to Periodically Saturated Soil 1.5 ft.
MSTS
a division of WRM Services, Inc.
Phone: (320) 398-2705 Fax: (320) 398-2075
www.millerssewaize.com
S. Soil separation — Compliance component #5 of 5
Date of installation 1/23/1997 ❑ Unknown
(mmlddlyyyy)
Shoreland/Wellhead protection/Food
beverage lodging?
Hance criteria (select
5a. For systems built prior to April 1, 1996,
and 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
(Advanced Inspector License required)
Drainfield meets the designed vertical
separation distance from periodically
saturated soil or bedrock.
❑ Yes ® No
❑ Yes ❑ No*
® Yes ❑ No*
❑ Yes ❑ No*
*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 (Attach)
❑ Two previous verifications of required vertical
separation (Attach)
❑ Not applicable (No soil treatment area)
Indicate depths or elevations
A. Bottom of distribution media
Elev.=102.0
B. Periodically saturated soil/bedrock
Elev.=98.5
C. System separation
>3.0 ft.
D. Required compliance separation*
3.0 ft.*
*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.
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Tank Report
Elmer .l. Peterson Co.
5921 Dague Ave.
Delano, MN 65328
Phone 763-972-2420
Fax 763-972-7217
MPCA License# 219
Mark Capece
511 Ferndale Road N
Orono, MN
612-325-5434
Baffles:( J, / OFF
Tank Capacity: 3-1000 Gallon Tanks
# of Tanks: 3
Type of Tanks:
Gallons Pumped
Concrete
2500
Manholes to Grade: YES / NO
Comments:
Date: May 5, 2023
On May 5, 2023, Elmer J. Peterson Co. uncovered 1' manhole (8 inches deep) and pumped tanks. 2"d manhole
and pump tank manhole to grade. 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.
MINNESOTA POLLUTION
CONTROL AGENCY Sewage tank integrity assessment form
520 Lafayette Road North Subsurface Sewage
St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program
Dow: 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://www.-pc@.state.Mn.us/water/inspections.
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 - Existing system (oro -v wists4-31 b1. This form can be found on
the MPCA website at https://www pca.statemn_us/waterlinspections.
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 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(B),(C),
and (D) and; Minn. R. 7083.0730(C).
Owner information
Owner/Representative Mark Capece
Property address: 511 Ferndale Road N Orono, MN
Local Regulatory Authority:
status
System status on date (mm/dd/yyyy): 5/5/2023
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 El Yes* ®No
Groundwater."
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect El Yes* ®No
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 ❑ Yes* ® No
Public Health or Safety."
Any "yes" answer above indicates sewage tank non-compliance.
Company information
Company name: Elmer J. Peterson Cc _
Business license number: 219
Designated Certified Individual (DCI) information
Print name: James L Braegelmann
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/dd/yyyy): 5/5/2023
(This document has been electronically signed.)
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